MEDICARE: TRAVIS J SLABA PA-C

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	363A00000X	Physician Assistant	0541	SD
2	363AM0700X	Medical Physician Assistant	0541	SD

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	:	1295732709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS J SLABA PA-C

Provider Business Mailing Address
First Line	:	1200 S 7TH AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-0900
Country	:	US
Telephone Number	:	605-504-5400
Fax Number	:	605-504-5150

Provider Business Practice Location Address
First Line	:	220 S CLIFF AVE STE 120
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032-2117
Country	:	US
Telephone Number	:	605-213-8000
Fax Number	:	605-213-8005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	04/19/2022

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Directions to “ TRAVIS J SLABA PA-C” Practice Location

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