| NPI | 1871638072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELINDA BETH JONES Medical Billing Specialist 605-178-3219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 3963) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 1382) |
| 207R00000X Internal Medicine (Licence: SD 2150) | |
| 207R00000X Internal Medicine (Licence: SD 5432) | |
| 208000000X Pediatrics (Licence: SD 4739) | |
| 208000000X Pediatrics (Licence: SD 5507) | |
| 208600000X Surgery (Licence: SD 3563) | |
| 208600000X Surgery (Licence: SD 4023) | |
| 208600000X Surgery (Licence: SD 2113) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: SD R024930) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: SD CP000457) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |