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General NPI Number Information
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NPI Number | 1033195912
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 310 S PENNSYLVANIA ST SUITE 201
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City | ABERDEEN
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State | SD
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Zip | 57401-4553
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Country | US
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Telephone | 605-229-1367
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Fax | 605-229-1002
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Provider Business Mailing Address
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Address Line | 310 S PENNSYLVANIA ST SUITE 201
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City | ABERDEEN
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State | SD
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Zip | 57401-4553
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Country | US
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Telephone | 605-229-1367
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Fax | 605-229-1002
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. BRADLEY W OLSON
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Credential |
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Telephone | 605-229-1367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 48090
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License Number State | SD
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