1851369763 NPI number — GREAT PLAINS EYE CLINIC LTD

Table of content: (NPI 1851369763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851369763 NPI number — GREAT PLAINS EYE CLINIC LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT PLAINS EYE CLINIC LTD
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:
1851369763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 S MINNESOTA AVE
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:
57105-1751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-334-7715
Provider Business Mailing Address Fax Number:
605-334-8247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 S MINNESOTA AVE
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:
57105-1751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-334-7715
Provider Business Practice Location Address Fax Number:
605-334-8247
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
CLEMENT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
605-334-7715

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  2075 , 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: 0007123 . This is a "BLUE CROSS/SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 301784 . This is a "AVERA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7123 . This is a "GEHA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 25443 . This is a "SIOUX VALLEY HEALTH PLAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 01014670 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 90258WH . This is a "BLUE CROSS/SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6300190 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007123 . This is a "WELLMARK ADMINISTRATORS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 6300190 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com