Healthcare Provider Details

I. General information

NPI: 1134302482
Provider Name (Legal Business Name): SETLIFF SINUS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 JACKSON BLVD STE # 2
RAPID CITY SD
57702-4396
US

IV. Provider business mailing address

PO BOX 5126
SIOUX FALLS SD
57117-5126
US

V. Phone/Fax

Practice location:
  • Phone: 605-348-9714
  • Fax:
Mailing address:
  • Phone: 605-335-1952
  • Fax: 605-373-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: REUBEN C SETLIFF III
Title or Position: OWNER AND PROVIDER
Credential: MD
Phone: 605-339-1872