Healthcare Provider Details

I. General information

NPI: 1093792244
Provider Name (Legal Business Name): CJ ELMWOOD PARTNERS L P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S ELMWOOD AVE
SIOUX FALLS SD
57105-6565
US

IV. Provider business mailing address

3801 S ELMWOOD AVE
SIOUX FALLS SD
57105-6565
US

V. Phone/Fax

Practice location:
  • Phone: 800-338-2015
  • Fax: 605-334-0737
Mailing address:
  • Phone: 800-338-2015
  • Fax: 605-334-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number11147
License Number StateSD

VIII. Authorized Official

Name: DR. CHARLES E JONES
Title or Position: PARTNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 712-239-3937