Healthcare Provider Details

I. General information

NPI: 1508041344
Provider Name (Legal Business Name): THE MIDLANDS CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SIOUX VALLEY DR
CHEROKEE IA
51012-1205
US

IV. Provider business mailing address

705 SIOUX POINT ROAD SUITE 100
DAKOTA DUNES SD
57049-5091
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-5500
  • Fax: 605-217-5515
Mailing address:
  • Phone: 605-217-5500
  • Fax: 605-217-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEANNA L BURKE
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 605-217-5557