1043598337 NPI number — DAKOTA ENDOCRINOLOGY LLC

Table of content: (NPI 1043598337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043598337 NPI number — DAKOTA ENDOCRINOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAKOTA ENDOCRINOLOGY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043598337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57117-5126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-335-1952
Provider Business Mailing Address Fax Number:
605-373-9971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 W 69TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57108-8148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-977-7000
Provider Business Practice Location Address Fax Number:
605-977-7001
Provider Enumeration Date:
08/03/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EID
Authorized Official First Name:
WAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
605-221-6010

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)