Healthcare Provider Details

I. General information

NPI: 1649364894
Provider Name (Legal Business Name): MIDLANDS CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

705 N SIOUX POINT RD 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: DR. KEITH VOLLSTEDT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 605-217-5500