1952384216 NPI number — DUNES MEDICAL LABORATORIES

Table of content: (NPI 1952384216)

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:
MERCYONE DAKOTA DUNES MEDICAL LABORATORIES
Provider Other Organization Name Type Code:
3
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:
02/19/2020
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:
FLANNERY-HUGHES
Authorized Official First Name:
M. ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
712-279-2018

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: 5581310 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0508259 , issued by the state of ( IA ) . 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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