1952384216 NPI number — DUNES MEDICAL LABORATORIES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952384216 NPI number — DUNES MEDICAL LABORATORIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUNES MEDICAL LABORATORIES
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:
1952384216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51102-1463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-279-2263
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 TOWER RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
DAKOTA DUNES
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-232-4270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HANSON
Authorized Official First Name:
JESICA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
712-279-5850

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0508259 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5581310 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005376 . This is a "WELLMARK SD BLUE SHILED" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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