Healthcare Provider Details

I. General information

NPI: 1083992010
Provider Name (Legal Business Name): NATHAN H LOEWEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 3RD ST SE
HURON SD
57350-2502
US

IV. Provider business mailing address

118 3RD ST SE
HURON SD
57350-2502
US

V. Phone/Fax

Practice location:
  • Phone: 605-352-2117
  • Fax: 605-554-2200
Mailing address:
  • Phone: 605-352-2117
  • Fax: 605-554-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3517
License Number StateSD

VIII. Authorized Official

Name: DR. NATHAN H LOEWEN
Title or Position: OWNER
Credential: MD
Phone: 605-352-2117