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General NPI Number Information
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NPI Number | 1104201599
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Entity Type | Organization
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Legal Business Name | SIOUX FALLS CENTER FOR PLASTIC AND RECONSTRUCTIVE SURGERY
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 6301 S MINNESOTA AVE SUITE 300
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2528
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Country | US
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Telephone | 605-334-1930
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Fax | 605-334-0926
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Provider Business Mailing Address
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Address Line | 6301 S MINNESOTA AVE SUITE 300
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2528
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Country | US
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Telephone | 605-334-1930
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Fax | 605-334-0926
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Authorized Official
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Title or Position | MANAGER
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Name | JACLYN SMALL
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Credential |
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Telephone | 605-334-1930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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