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NPI Code Detail

MEDICARE: HURON LABORATORY SVC PC

MEDICARE: HURON LABORATORY SVC 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
1207ZP0101XAnatomic Pathology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1220023870OTHERSDRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
20005771OTHERSDBLUE CROSS SD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437155744
Entity Type Code : Organization
Provider Name (Legal Business Name) : HURON LABORATORY SVC PC
Provider Business Mailing Address
First Line : 400 E 10TH ST
Second Line :
City : WACONIA
State : MN
Zip : 55387-4552
Country : US
Telephone Number : 952-442-9770
Fax Number : 952-442-3620
Provider Business Practice Location Address
First Line : 172 4TH ST SE
Second Line :
City : HURON
State : SD
Zip : 57350-2510
Country : US
Telephone Number : 605-353-6200
Fax Number : 952-442-3620
Authorized Official
Title or Position : PRESIDENT
Name : JEFFREY VAN WINKLE
Credential :
Telephone Number : 605-940-6410
Provider Enumeration Date : 06/22/2005
Last Update Date : 12/29/2016

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Directions to “HURON LABORATORY SVC PC ” Practice Location

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