Healthcare Provider Details

I. General information

NPI: 1518980440
Provider Name (Legal Business Name): STATE OF SOUTH DAKOTA DIVISION OF OASI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E CAPITOL AVE
PIERRE SD
57501-2536
US

IV. Provider business mailing address

600 E CAPITOL AVE
PIERRE SD
57501-2536
US

V. Phone/Fax

Practice location:
  • Phone: 605-773-4749
  • Fax: 605-773-5683
Mailing address:
  • Phone: 605-773-3361
  • Fax: 605-773-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier5400090
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: MS. KARI JEAN WEISBECK
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-773-4939