MEDICARE: GENERAL SURGERY AND DIAGNOSTICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003860594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERAL SURGERY AND DIAGNOSTICS PC

Provider Business Mailing Address
First Line	:	612 N SIOUX POINT RD
Second Line	:	SUITE 400
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5088
Country	:	US
Telephone Number	:	605-232-6353
Fax Number	:

Provider Business Practice Location Address
First Line	:	612 N SIOUX POINT RD
Second Line	:	SUITE 400
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5088
Country	:	US
Telephone Number	:	605-232-6353
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT OFFICE MANAGER
Name	:	CINDY HESSE
Credential	:
Telephone Number	:	605-232-6353

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	10/31/2007

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