Healthcare Provider Details

I. General information

NPI: 1033306543
Provider Name (Legal Business Name): SIOUX VALLEY SCHOOL DISTRICT 5 5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HANSINA AVE
VOLGA SD
57071-0278
US

IV. Provider business mailing address

PO BOX 278
VOLGA SD
57071-0278
US

V. Phone/Fax

Practice location:
  • Phone: 605-627-5657
  • Fax: 605-627-5291
Mailing address:
  • Phone: 605-627-5657
  • Fax: 605-627-5291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5150430
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: MRS. ARDITH C VAN BEEK
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-627-5657