1447223821 NPI number — DR. CLYDE A DIEDE DC

Table of content: DR. CLYDE A DIEDE DC (NPI 1447223821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447223821 NPI number — DR. CLYDE A DIEDE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIEDE
Provider First Name:
CLYDE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1447223821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
337 SOUTH MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINNER
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57580-1728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-842-0544
Provider Business Mailing Address Fax Number:
605-842-0544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
337 SOUTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNER
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57580-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-842-0544
Provider Business Practice Location Address Fax Number:
605-842-0544
Provider Enumeration Date:
02/08/2006

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: 111N00000X , with the licence number:  826 , 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: 0003826 . This is a "BCBS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7600320 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18336 . This is a "MEDICAID" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 410238 . This is a "ACN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26403 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 241873 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33246 . This is a "SIOUX VALLEY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com