1952371825 NPI number — DR. KANDI MCMENAMY MD

Table of content: DR. KANDI MCMENAMY MD (NPI 1952371825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952371825 NPI number — DR. KANDI MCMENAMY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMENAMY
Provider First Name:
KANDI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1952371825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 86370
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:
57118-6370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-322-7510
Provider Business Mailing Address Fax Number:
605-322-6475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 S. CLIFF 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:
57105-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-322-4425
Provider Business Practice Location Address Fax Number:
605-322-4499
Provider Enumeration Date:
01/24/2006

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: 2080N0001X , with the licence number:  3674 , 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: 161221200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27T86MC . This is a "CC SYSTEMS/BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4700069 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4999722 . This is a "BCBS SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: HP32483 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0972414 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 603795 . This is a "ARAZ/AMERICA'S PPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 34573 . This is a "SANFORD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6701090 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3674 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4700116 . This is a "UNITEDHEALTHCARE NE MA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 13988 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 57105L003 . This is a "TPS TRICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 769221017456 . This is a "PREFERRED ONE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com