Basic Information
| Provider Information | |||||||||
| NPI: | 1235196056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCHALE INSTITUTE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3720 W 69TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053394464 | ||||||||
| FaxNumber: | 6053390309 | ||||||||
| Practice Location | |||||||||
| Address1: | 3720 W 69TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053394464 | ||||||||
| FaxNumber: | 6053390309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | BOLLER | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4024351400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 1762 | SD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1229 | 01 | AVERA | OTHER | S40331 | 01 | SD | PTAN | OTHER | 268R3NO | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 9203322 | 01 | SD | DAKOTACARE | OTHER | 0040331 | 01 | SD | BLUE CROSS BLUE SHIELD | OTHER |