Healthcare Provider Details

I. General information

NPI: 1700050499
Provider Name (Legal Business Name): PHYSICIANS LABORATORY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SOUTH CLIFF AVENUE SUITE 700
SIOUX FALLS SD
57105-1019
US

IV. Provider business mailing address

PO BOX 5050
SIOUX FALLS SD
57117-5050
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-7200
  • Fax: 605-322-7222
Mailing address:
  • Phone: 605-322-7200
  • Fax: 605-322-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEE J BRANDT
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-322-7208