Provider Demographics
NPI:1538149455
Name:COUNTY OF JERAULD
Entity type:Organization
Organization Name:COUNTY OF JERAULD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JERAULD COUNTY AUDITOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGERHAUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-539-9301
Mailing Address - Street 1:604 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:WESSINGTON SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57382-2166
Mailing Address - Country:US
Mailing Address - Phone:605-539-1201
Mailing Address - Fax:605-539-4580
Practice Address - Street 1:604 1ST ST NE
Practice Address - Street 2:
Practice Address - City:WESSINGTON SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57382-2166
Practice Address - Country:US
Practice Address - Phone:605-539-1201
Practice Address - Fax:605-539-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9000530Medicaid
SD0099040OtherBC BS
SDS99040OtherMEDICARE PROVIDER#
SD9000530Medicaid