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NPI Code Detail

MEDICARE: STATE OF SOUTH DAKOTA

MEDICARE: STATE OF SOUTH DAKOTA
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
1283Q00000XPsychiatric Hospital10577SD

Other Identifiers

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

General Provider Information

NPI Number : 1124027586
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF SOUTH DAKOTA
Provider Business Mailing Address
First Line : PO BOX 7600
Second Line :
City : YANKTON
State : SD
Zip : 57078-7600
Country : US
Telephone Number : 605-668-3148
Fax Number : 605-668-5407
Provider Business Practice Location Address
First Line : 3515 BROADWAY AVE
Second Line :
City : YANKTON
State : SD
Zip : 57078-7600
Country : US
Telephone Number : 605-668-3148
Fax Number : 605-668-5407
Authorized Official
Title or Position : BUSINESS MANAGER
Name : MR. DAVID GEISE
Credential :
Telephone Number : 605-668-3148
Provider Enumeration Date : 07/19/2005
Last Update Date : 04/24/2009

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Directions to “STATE OF SOUTH DAKOTA ” Practice Location

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