Healthcare Provider Details

I. General information

NPI: 1174689137
Provider Name (Legal Business Name): LOIS I TRUH, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 DAKOTA AVE S
HURON SD
57350-2726
US

IV. Provider business mailing address

807 DAKOTA AVE S
HURON SD
57350-2726
US

V. Phone/Fax

Practice location:
  • Phone: 605-352-7070
  • Fax: 605-352-6878
Mailing address:
  • Phone: 605-352-7070
  • Fax: 605-352-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3465
License Number StateSD

VIII. Authorized Official

Name: DR. LOIS ILEAN TRUH
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 605-352-7070