1144380866 NPI number — DR. TAWA M WITKO PSYD

Table of content: DR. TAWA M WITKO PSYD (NPI 1144380866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144380866 NPI number — DR. TAWA M WITKO PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITKO
Provider First Name:
TAWA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

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:
1144380866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 879
Provider Second Line Business Mailing Address:
MCLAUGHLIN CLINIC
Provider Business Mailing Address City Name:
MC LAUGHLIN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57642-0879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-823-4458
Provider Business Mailing Address Fax Number:
605-823-4459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 E 6TH ST
Provider Second Line Business Practice Location Address:
MCLAUGHLIN CLINIC
Provider Business Practice Location Address City Name:
MCLAUGHLIN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-823-4458
Provider Business Practice Location Address Fax Number:
605-823-4459
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  456 , 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: 246779 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 246779 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 456 . This is a "DAKOTA CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DB3096 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14283 . This is a "AVERA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6552242 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 246779 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4994787 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10025457300 . This is a "NEBRASKA MEDICAID" identifier . This identifiers is of the category "OTHER".




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