Healthcare Provider Details

I. General information

NPI: 1609955939
Provider Name (Legal Business Name): MEDICAL ASSOCIATES CLINIC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LANE
PIERRE SD
57501-0758
US

IV. Provider business mailing address

100 MAC LANE P. O. BOX 758
PIERRE SD
57501-0758
US

V. Phone/Fax

Practice location:
  • Phone: 605-945-5210
  • Fax: 605-945-3244
Mailing address:
  • Phone: 605-945-5210
  • Fax: 605-945-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number11146
License Number StateSD

VIII. Authorized Official

Name: PAT K GORDON
Title or Position: HR
Credential:
Phone: 605-945-5214