=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255408977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIOUX FALLS PRIMARY CARE SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 10/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5027 S BUR OAK PL
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57108-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-271-7600
-----------------------------------------------------
Fax | 605-271-7602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3270 FOLKWAYS BLVD SUITE 101
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68504-1264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-435-1400
-----------------------------------------------------
Fax | 402-435-1404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND PROVIDER
-----------------------------------------------------
Name | RICHARD L PLUMMER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 605-271-7600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------