| NPI | 1326551623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA HEIMENSEN Credentialing Manager 605-217-5611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2025-09-23 |