Healthcare Provider Details

I. General information

NPI: 1215091145
Provider Name (Legal Business Name): SIOUX VALLEY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 8TH ST N
MOUNTAIN LAKE MN
56159-1568
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 507-427-3332
  • Fax:
Mailing address:
  • Phone: 605-328-4540
  • Fax: 605-328-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE W GOETSCH
Title or Position: CFO
Credential:
Phone: 605-328-6940