Basic Information
Provider Information
NPI: 1174529929
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BELL
FirstName: MARIA
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5074
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571175074
CountryCode: US
TelephoneNumber: 6053289556
FaxNumber: 6053289501
Practice Location
Address1: 1500 W 22ND ST
Address2: STE 102
City: SIOUX FALLS
State: SD
PostalCode: 571051503
CountryCode: US
TelephoneNumber: 6053287700
FaxNumber: 6053287775
Other Information
ProviderEnumerationDate: 06/27/2005
LastUpdateDate: 04/17/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VX0201X4682SDY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology

ID Information
IDTypeStateIssuerDescription
620124205SD MEDICAID


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