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General NPI Number Information
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NPI Number | 1548434889
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Entity Type | Organization
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Legal Business Name | SCSA DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 807 32ND AVE
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City | BROOKINGS
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State | SD
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Zip | 57006-4716
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Country | US
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Telephone | 605-692-5938
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Fax | 605-692-9730
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Provider Business Mailing Address
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Address Line | 807 32ND AVE
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City | BROOKINGS
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State | SD
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Zip | 57006-4716
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Country | US
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Telephone | 605-692-5938
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Fax | 605-692-9730
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | DR. DONALD PAUL EVENSON
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Credential | PH.D, HCLD
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Telephone | 605-692-5938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | SD
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