Healthcare Provider Details

I. General information

NPI: 1295802619
Provider Name (Legal Business Name): WEBER MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PUGH STREET
MARTIN SD
57551-0370
US

IV. Provider business mailing address

PO BOX 370
MARTIN SD
57551-0370
US

V. Phone/Fax

Practice location:
  • Phone: 605-685-1450
  • Fax: 605-685-1453
Mailing address:
  • Phone: 605-685-1450
  • Fax: 605-685-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0304
License Number StateSD

VIII. Authorized Official

Name: DIANE M WEBER
Title or Position: OWNER
Credential: PA C
Phone: 605-685-1450