Healthcare Provider Details

I. General information

NPI: 1831105022
Provider Name (Legal Business Name): JOHN ERIC MYSKIW PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/05/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLACK HILLS HEALTHCARE 113 COMANCHE RD
FORT MEADE SD
57741
US

IV. Provider business mailing address

11904 BUCK LN
CUSTER SD
57730-7272
US

V. Phone/Fax

Practice location:
  • Phone: 605-347-2511
  • Fax:
Mailing address:
  • Phone: 605-517-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: