Basic Information
| Provider Information | |||||||||
| NPI: | 1497782882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISHOP | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | K | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 MICKELSON DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572017253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058820432 | ||||||||
| FaxNumber: | 6058820978 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 MICKELSON DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572017253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058820432 | ||||||||
| FaxNumber: | 6058820978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 02/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 4977 | SD | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300127946 | 01 | SD | RAILROAD MEDICARE | OTHER | 377027300 | 05 | MN | MEDICAID | 0008564 | 01 | SD | BCBS | OTHER | 7200630 | 05 | SD | MEDICAID |