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NPI Code Detail

MEDICARE: ROY L MORTINSEN M.D.

MEDICARE: ROY L MORTINSEN M.D.
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
1207Q00000XFamily Medicine Physician5066SD
2207P00000XEmergency Medicine Physician5066SD

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 : 1417954918
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY L MORTINSEN M.D.
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-328-4539
Fax Number : 605-328-4531
Provider Business Practice Location Address
First Line : 20 S PLUM ST
Second Line :
City : VERMILLION
State : SD
Zip : 57069-3346
Country : US
Telephone Number : 605-624-9111
Fax Number : 605-624-6636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 03/25/2022

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