Basic Information
| Provider Information | |||||||||
| NPI: | 1013987478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUDEBUSCH | ||||||||
| FirstName: | MISTY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 S MAIN | ||||||||
| Address2: | |||||||||
| City: | HOWARD | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057724426 | ||||||||
| FaxNumber: | 6057724261 | ||||||||
| Practice Location | |||||||||
| Address1: | 213 S MAIN | ||||||||
| Address2: | |||||||||
| City: | HOWARD | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057724426 | ||||||||
| FaxNumber: | 6057724261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 11/16/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 448 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 243580 | 01 | SD | MIDLAND'S CHOICE | OTHER | 5300492 | 05 | SD | MEDICAID | 9235848 | 01 | SD | DAKOTACARE | OTHER | P00183707 | 01 | SD | RR MEDICARE | OTHER | 01-18249 | 01 | SD | MEDICA | OTHER | 4995481 | 01 | SD | WELLMARK | OTHER | AH1341033452 | 01 | SD | PREFERRED ONE | OTHER | S1639 | 01 | SD | MEDICARE PTAN | OTHER | 1107619 | 01 | SD | AMERICA'S PPO | OTHER |