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General NPI Number Information
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NPI Number | 1275353237
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Entity Type | Organization
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Legal Business Name | PAX PLLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 6709 S MINNESOTA AVE STE 101
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2593
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Country | US
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Telephone | 605-366-6569
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S CLIFF AVE STE 101
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City | SIOUX FALLS
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State | SD
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Zip | 57104-5276
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Country | US
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Telephone | 605-339-0002
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ANDREW MORTENSON
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Credential | MD
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Telephone | 605-366-6569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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