MEDICARE: MITCHELL DIAGNOSTIC

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	247100000X	Radiologic Technologist	42168	SD
2	2471B0102X	Bone Densitometry Radiologic Technologist	42168	SD
3	246XS1301X	Sonography Specialist/Technologist Cardiovascular	48461	SD
4	246XC2903X	Vascular Specialist/Technologist Cardiovascular	48461	SD
5	374700000X	Technician	18136	SD
6	2471N0900X	Nuclear Medicine Technology Radiologic Technologist	42168	SD
7	291U00000X	Clinical Medical Laboratory	43D0407438	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	690006160	OTHER	SD	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1770513475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL DIAGNOSTIC

Provider Business Mailing Address
First Line	:	2250 N KIMBALL ST STE 600
Second Line	:
City	:	MITCHELL
State	:	SD
Zip	:	57301-5335
Country	:	US
Telephone Number	:	605-996-2031
Fax Number	:	605-996-4496

Provider Business Practice Location Address
First Line	:	2250 N KIMBALL ST STE 600
Second Line	:
City	:	MITCHELL
State	:	SD
Zip	:	57301-5335
Country	:	US
Telephone Number	:	605-996-2031
Fax Number	:	605-996-4496

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. MARY PARR
Credential	:
Telephone Number	:	605-996-2031

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	05/29/2008

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Directions to “MITCHELL DIAGNOSTIC ” Practice Location

Language	Start Address	Practice Location

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