Healthcare Provider Details

I. General information

NPI: 1932769718
Provider Name (Legal Business Name): SSD CARE OF SD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 W 22ND ST STE 100
SIOUX FALLS SD
57105-1745
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 350
NASHVILLE TN
37205-2216
US

V. Phone/Fax

Practice location:
  • Phone: 615-733-2064
  • Fax:
Mailing address:
  • Phone: 615-733-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD LELAND HUTTON EADIE
Title or Position: MANAGING EMPLOYEE
Credential:
Phone: 615-733-2064