Healthcare Provider Details

I. General information

NPI: 1386620607
Provider Name (Legal Business Name): GPPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 S CARNEGIE PL
SIOUX FALLS SD
57106-2360
US

IV. Provider business mailing address

4105 S CARNEGIE PL
SIOUX FALLS SD
57106-2360
US

V. Phone/Fax

Practice location:
  • Phone: 605-323-2345
  • Fax: 605-323-2822
Mailing address:
  • Phone: 605-323-2345
  • Fax: 605-323-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONALD SCOTT PRIBYL
Title or Position: ADMINISTRATOR
Credential: EDD
Phone: 605-323-2345