Healthcare Provider Details

I. General information

NPI: 1366603466
Provider Name (Legal Business Name): REID ALYN SUTTON H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S LOUISE AVE
SIOUX FALLS SD
57106-0704
US

IV. Provider business mailing address

3201 S LOUISE AVE
SIOUX FALLS SD
57106-0704
US

V. Phone/Fax

Practice location:
  • Phone: 605-906-6005
  • Fax:
Mailing address:
  • Phone: 605-906-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number284H
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: