Healthcare Provider Details

I. General information

NPI: 1336432228
Provider Name (Legal Business Name): ORTHOPEDICS INTERNATIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 LOCUST ST
YANKTON SD
57078-2030
US

IV. Provider business mailing address

2007 LOCUST ST
YANKTON SD
57078-2030
US

V. Phone/Fax

Practice location:
  • Phone: 605-689-6890
  • Fax: 605-689-6896
Mailing address:
  • Phone: 605-689-6890
  • Fax: 605-689-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4099
License Number StateSD

VIII. Authorized Official

Name: DIANE K FUKS
Title or Position: OFFICE MANAGER
Credential:
Phone: 605-689-6890