1760569248 NPI number — SURGICAL INSTITUTE OF SOUTH DAKOTA, PC

Table of content: VICTORIA CAMILLE REYNOLDS RDN (NPI 1528816758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760569248 NPI number — SURGICAL INSTITUTE OF SOUTH DAKOTA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL INSTITUTE OF SOUTH DAKOTA, PC
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:
6
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:
1760569248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 E. 20TH ST.
Provider Second Line Business Mailing Address:
STE. 700
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57105-1049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-334-0393
Provider Business Mailing Address Fax Number:
605-334-6028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 E. 20TH ST.
Provider Second Line Business Practice Location Address:
STE. 700
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-334-0393
Provider Business Practice Location Address Fax Number:
605-334-6028
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HATTING
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
605-334-0393

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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