Provider Demographics
NPI:1972821007
Name:LORI L GIEDT
Entity type:Organization
Organization Name:LORI L GIEDT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GIEDT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-397-2363
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:SD
Mailing Address - Zip Code:57445-0347
Mailing Address - Country:US
Mailing Address - Phone:605-397-2363
Mailing Address - Fax:605-397-4403
Practice Address - Street 1:1205 N 1ST ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:SD
Practice Address - Zip Code:57445-2329
Practice Address - Country:US
Practice Address - Phone:605-397-2363
Practice Address - Fax:605-397-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-0002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9166940OtherMEDICAID DME
SD8502070Medicaid
SD8502070Medicaid