Basic Information
| Provider Information | |||||||||
| NPI: | 1083992010 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NATHAN H LOEWEN | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NEW LIFE FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 118 3RD ST SE | ||||||||
| Address2: | |||||||||
| City: | HURON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 573502502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053522117 | ||||||||
| FaxNumber: | 6055542200 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 3RD ST SE | ||||||||
| Address2: | |||||||||
| City: | HURON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 573502502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053522117 | ||||||||
| FaxNumber: | 6055542200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2011 | ||||||||
| LastUpdateDate: | 03/26/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LOEWEN | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6053522117 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3517 | SD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.