Basic Information
| Provider Information | |||||||||
| NPI: | 1235898073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR FAMILY MEDICINE CHWS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 E 20TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053391783 | ||||||||
| FaxNumber: | 6053677157 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 E 20TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053391783 | ||||||||
| FaxNumber: | 6053677157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2021 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | KATIE | ||||||||
| AuthorizedOfficialMiddleName: | MAE | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 6055751608 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.