Healthcare Provider Details

I. General information

NPI: 1306892633
Provider Name (Legal Business Name): SCOTT W ECKLUND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N SYCAMORE AVE
SIOUX FALLS SD
57110-5745
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-2999
  • Fax: 605-328-2957
Mailing address:
  • Phone: 605-328-2999
  • Fax: 605-328-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1513
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1513
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: