Healthcare Provider Details

I. General information

NPI: 1972751766
Provider Name (Legal Business Name): ARLINGTON MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W. BIRCH
ARLINGTON SD
57212
US

IV. Provider business mailing address

104 W. BIRCH ST PO BOX 291
ARLINGTON SD
57212
US

V. Phone/Fax

Practice location:
  • Phone: 605-983-3293
  • Fax: 605-983-5112
Mailing address:
  • Phone: 605-983-3293
  • Fax: 605-983-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number0173
License Number StateSD

VIII. Authorized Official

Name: MR. AMIEL N REDFISH
Title or Position: OWNER
Credential: PA
Phone: 605-983-3283