Healthcare Provider Details

I. General information

NPI: 1780653899
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S LLOYD ST STE E101
ABERDEEN SD
57401
US

IV. Provider business mailing address

201 S LLOYD ST STE E101
ABERDEEN SD
57401
US

V. Phone/Fax

Practice location:
  • Phone: 605-225-8800
  • Fax: 605-225-1302
Mailing address:
  • Phone: 605-225-8800
  • Fax: 605-225-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RICK L KIENOW
Title or Position: MANAGER
Credential:
Phone: 605-225-8800