MEDICARE: DV SURGICAL

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	332B00000X	Durable Medical Equipment & Medical Supplies		SD

General Provider Information

NPI Number	:	1073009916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DV SURGICAL

Provider Business Mailing Address
First Line	:	451 E SAWGRASS TRL
Second Line	:
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5269
Country	:	US
Telephone Number	:	712-230-0305
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 RIVER DR
Second Line	:
City	:	NORTH SIOUX CITY
State	:	SD
Zip	:	57049-3015
Country	:	US
Telephone Number	:	712-230-0305
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NATHAN JAMES SCHIPPER
Credential	:
Telephone Number	:	712-230-0305

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	07/03/2018

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