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General NPI Number Information
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NPI Number | 1578988804
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Entity Type | Organization
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Legal Business Name | SMART MEDICAL CLINIC
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Dates
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Enumeration Date | 02/24/2014
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 1905 W 57TH ST STE 1A
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2893
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Country | US
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Telephone | 605-310-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 W 57TH ST STE 1A
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2893
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Country | US
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Telephone | 605-310-2000
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LEANN BATIZ
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Credential | CNP
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Telephone | 605-251-1154
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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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