Basic Information
| Provider Information | |||||||||
| NPI: | 1447343827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAKOTA WEST RADIATION ONCOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8010 | ||||||||
| Address2: | 353 FAIRMONT BLVD | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057198559 | ||||||||
| FaxNumber: | 6057192310 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 FAIRMONT BLVD | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057198559 | ||||||||
| FaxNumber: | 6057192310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EASTINO | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | STENER | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6057198559 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0002528 | 01 | SD | BLUE CROSS BLUE SHIELD | OTHER | C04620 | 01 | RAILROAD MEDICARE | OTHER |