Basic Information
| Provider Information | |||||||||
| NPI: | 1609809094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEEHAN | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S. MINNESOTA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571053762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 S. CLIFF AVE | ||||||||
| Address2: | STE 610 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053228860 | ||||||||
| FaxNumber: | 6053228868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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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 | 363AS0400X | 0571 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 10025568900 | 05 | NE | MEDICAID | 1821021304 | 05 | IA | MEDICAID | 9238709 | 01 | SD | DAKOTACARE | OTHER | 46L92ME | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 4992676 | 01 | SD | BLUE CROSS | OTHER | 1609809094 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 248340 | 01 | SD | MIDLANDS CHOICE | OTHER | 0127834 | 01 | SD | MEDICA | OTHER | 248340 | 01 | SD | MIDLAND'S CHOICE | OTHER | 6827152 | 05 | SD | MEDICAID | C83141041559 | 01 | SD | PREFERRED ONE | OTHER | 57105AT04 | 01 | SD | WPS TRICARE | OTHER |