1174689137 NPI number — LOIS I TRUH, MD

Table of content: (NPI 1174689137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174689137 NPI number — LOIS I TRUH, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOIS I TRUH, MD
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:
LOIS I TRUH, MD
Provider Other Organization Name Type Code:
3
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:
1174689137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
807 DAKOTA AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57350-2726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-352-7070
Provider Business Mailing Address Fax Number:
605-352-6878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 DAKOTA AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57350-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-352-7070
Provider Business Practice Location Address Fax Number:
605-352-6878
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRUH
Authorized Official First Name:
LOIS
Authorized Official Middle Name:
ILEAN
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
605-352-7070

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  3465 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0002559 . This is a "WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 02608860277 . This is a "AMA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5608102 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3465 . This is a "SD STATE LICENSE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 22458 . This is a "SIOUX VALLEY INSURANCE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 3465 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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