Healthcare Provider Details

I. General information

NPI: 1881647246
Provider Name (Legal Business Name): UROLOGY SPECIALISTS CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 69TH ST
SIOUX FALLS SD
57108-2403
US

IV. Provider business mailing address

201 W 69TH ST
SIOUX FALLS SD
57108-2403
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-0635
  • Fax: 605-336-7182
Mailing address:
  • Phone: 605-336-0635
  • Fax: 605-336-7182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY WEEKS
Title or Position: CEO/CAO
Credential: MSN RN
Phone: 605-444-5409