Active NPI
Family Pharmacy of Mobridge Inc
- Community/Retail Pharmacy
- Mobridge, SD
National Provider Identifier
1407959539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 1001797
- Legal business name
- FAMILY PHARMACY OF MOBRIDGE INC
- Practice address
- 1317 10TH Ave W
Mobridge, SD 57601-1146 - Phone
- (605) 845-8140
- Fax
- (605) 845-8146
- NPI assigned
- Sep 6, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Levi Jensen
- Title
- President
- Phone
- (605) 845-8140
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Clinic Pharmacy | 3336C0002X | |||
| Community/Retail Pharmacy | 3336C0003X | 1001797 | SD | Primary |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
1317 10TH Ave W
Mobridge, SD 57601-1146
Mailing address
1317 10TH Ave W
Box 759
Mobridge, SD 57601-1146
Phone (605) 845-8140
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2093771 | Other | PK | |
| 8501062 | Medicaid | SD | |
| 020988 | Medicaid | ND |
Other names 1
- FAMILY PHARMACY-CLINIC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930053752 | SD | DME Supplier - Pharmacy | 1850412230 | Practice locations: Mobridge, SD |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Family Pharmacy | Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Insulin Infusion Pumps and/or Supplies|Ostomy Supplies|Enteral Nutrients|Nebulizer Equipment and/or Supplies | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Family Pharmacy of Mobridge Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Mobridge, SD
- NPI 1144243270
Locations
1317 10th Ave W
#759
Mobridge, SD 57601
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Mobridge, SD
- NPI 1326035429
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1646006400000",
"number": "1407959539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1317 10TH AVE W",
"address_2": "BOX 759",
"city": "MOBRIDGE",
"state": "SD",
"postal_code": "576011146",
"telephone_number": "605-845-8140",
"fax_number": "605-845-8146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1317 10TH AVE W",
"city": "MOBRIDGE",
"state": "SD",
"postal_code": "576011146",
"telephone_number": "605-845-8140",
"fax_number": "605-845-8146"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAMILY PHARMACY OF MOBRIDGE INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-06",
"last_updated": "2022-02-28",
"certification_date": "2022-01-31",
"status": "A",
"authorized_official_last_name": "JENSEN",
"authorized_official_first_name": "LEVI",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "605-845-8140"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0002X",
"taxonomy_group": "",
"desc": "Pharmacy, Clinic Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "SD",
"license": "1001797",
"primary": true
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2093771",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8501062",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "020988",
"state": "ND"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FAMILY PHARMACY-CLINIC",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "FAMILY PHARMACY-CLINIC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mobridge, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.