MEDICARE: 1 PSYCHIATRY P.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	2084P0800X	Psychiatry Physician	9089	SD

General Provider Information

NPI Number	:	1598251381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1 PSYCHIATRY P.C

Provider Business Mailing Address
First Line	:	211 SIOUX POINT RD STE 300
Second Line	:
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5492
Country	:	US
Telephone Number	:	605-242-0024
Fax Number	:	605-242-0026

Provider Business Practice Location Address
First Line	:	211 SIOUX POINT RD STE 300
Second Line	:
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5492
Country	:	US
Telephone Number	:	605-242-0024
Fax Number	:	605-242-0026

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ARADHNA PATRA
Credential	:
Telephone Number	:	605-242-0024

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	07/05/2018

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