Healthcare Provider Details

I. General information

NPI: 1407858954
Provider Name (Legal Business Name): LONNIE JOSEPH NEDVED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S BURR ST
MITCHELL SD
57301-4584
US

IV. Provider business mailing address

PO BOX 1203
MITCHELL SD
57301-7203
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-1050
  • Fax: 605-996-1051
Mailing address:
  • Phone: 605-996-1050
  • Fax: 605-996-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number3477
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00036138
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG48490
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier21514
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSIOUX VALLEY HEALTH PLAN
# 2
Identifier6200650
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 3
Identifier0001708
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerWELLMARK BCBS
# 4
Identifier3279
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerAVERA HEALTH PLAN
# 5
Identifier3477/GRP#8732644
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerDAKOTACARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: