MEDICARE: DAKOTA HILLS FAMILY PRACTICE

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	261QM1300X	Multi-Specialty Clinic/Center	1247	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	:	1609849165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAKOTA HILLS FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	30321 ROOSEVELT CT
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-6903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 BALLPARK RD
Second Line	:	SUITE 2
City	:	STURGIS
State	:	SD
Zip	:	57785-2364
Country	:	US
Telephone Number	:	605-720-1389
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DAVID LAUER
Credential	:
Telephone Number	:	605-720-1389

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	08/22/2020

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Directions to “DAKOTA HILLS FAMILY PRACTICE ” Practice Location

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