Basic Information
| Provider Information | |||||||||
| NPI: | 1033170543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OPHEIM | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 814 PIERCE ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122262600 | ||||||||
| FaxNumber: | 7122262605 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 W STEAMBOAT DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052172175 | ||||||||
| FaxNumber: | 6052172185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2006 | ||||||||
| LastUpdateDate: | 01/31/2011 | ||||||||
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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 | 207Q00000X | 2797 | SD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0040461 | 01 | SD | WELLMARK BCBS | OTHER | 47804 | 01 | IA | WELLMARK BCBS | OTHER | 75305796357049A003 | 01 | TRICARE | OTHER | 168 | 01 | MIDLANDS CHOICE | OTHER | 75305796315 | 05 | NE | MEDICAID | 9210414 | 01 | SD | DAKOTA CARE | OTHER | 20171 | 01 | SD | SIOUX VALLEY | OTHER | 2218222 | 05 | IA | MEDICAID | 7776144 | 05 | SD | MEDICAID |