Healthcare Provider Details

I. General information

NPI: 1962598029
Provider Name (Legal Business Name): MITCHELL BONE AND JOINT SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N FOSTER ST SUITE 200
MITCHELL SD
57301-2969
US

IV. Provider business mailing address

625 N FOSTER ST SUITE 200
MITCHELL SD
57301-2969
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-1800
  • Fax: 605-996-7272
Mailing address:
  • Phone: 605-996-1800
  • Fax: 605-996-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4899
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier6402082
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: DR. FELIX FLORES UNGACTA
Title or Position: OWNER
Credential: MD
Phone: 605-996-1800