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General NPI Number Information
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NPI Number | 1700229424
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Entity Type | Individual
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Provider Name | JESSICA SUE MATHISON SRSTKA MD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 6100 S LOUISE AVE STE 1130
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City | SIOUX FALLS
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State | SD
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Zip | 57108-6021
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Country | US
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Telephone | 605-504-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 S CLIFF AVE STE 300
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1032
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Country | US
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Telephone | 605-322-6625
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Fax | 605-322-6626
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101260280
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 11573
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License Number State | SD
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