Healthcare Provider Details

I. General information

NPI: 1821198144
Provider Name (Legal Business Name): JOSEPH LONCAREVICH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 6TH AVE W
LEMMON SD
57638-1318
US

IV. Provider business mailing address

1000 HIGHWAY 12
HETTINGER ND
58639-7530
US

V. Phone/Fax

Practice location:
  • Phone: 605-374-3773
  • Fax: 605-374-3425
Mailing address:
  • Phone: 701-567-4561
  • Fax: 701-567-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0093
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: