NPIMap

Organization Active NPI

Service Drug, Inc

  • Durable Medical Equipment & Medical Supplies
  • Scottsbluff, NE
National Provider Identifier
1861706715
Registry record updated Aug 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SERVICE DRUG, INC
Practice address
502 W 27TH St
Scottsbluff, NE 69361-4312
Phone
(308) 432-2400
Fax
(308) 432-4449
NPI assigned
Aug 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Drew Petersen
Title
Manager
Phone
(308) 432-2400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

502 W 27TH St
Scottsbluff, NE 69361-4312

Mailing address

302 Main St
Chadron, NE 69337-2395
Phone (308) 575-0400

Other names 1

  • PETERSEN DRUG Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101030000112 NE DME Supplier - PharmacyDME Supplier - Medical Supply CompanyDME Supplier - Oxygen & Equipment 1456493766 Practice locations: Scottsbluff, NE

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
Scottsbluff502 W 27TH St, Scottsbluff, NE 69361-4312(308) 575-0400 Commodes, Urinals, Bedpans|Continuous Passive Motion (CPM) Devices|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|Neuromuscular Elect Stimulators (NMES)/Supplies|Pneumatic Compression Devices and/or Supplies|Speech Generatin… Does not accept assignmentParticipating since Jul 1, 1966

National Provider Directory

National Provider Directory
Tax ID family
Service Drug Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280793600000",
    "number": "1861706715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 MAIN ST",
            "city": "CHADRON",
            "state": "NE",
            "postal_code": "693372395",
            "telephone_number": "308-575-0400",
            "fax_number": "308-575-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 W 27TH ST",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693614312",
            "telephone_number": "308-432-2400",
            "fax_number": "308-432-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERVICE DRUG, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-03",
        "last_updated": "2010-08-03",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "DREW",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "308-432-2400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PETERSEN DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scottsbluff, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; 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.

Verify at the official NPI Registry.