Basic Information
| Provider Information | |||||||||
| NPI: | 1700858248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VACA | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 W 69TH ST. | ||||||||
| Address2: | STE. 1500 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053225700 | ||||||||
| FaxNumber: | 6053225704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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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 | 2084P0800X | 3598 | SD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 57108D004 | 01 | SD | WPS TRICARE | OTHER | 7100903 | 05 | SD | MEDICAID | 0002435 | 01 | SD | BLUE CROSS | OTHER | 25001 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 595989 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 769191017551 | 01 | SD | PREFERRED ONE | OTHER | 160062 | 01 | MN | UCARE | OTHER | 3598 | 01 | SD | DAKOTACARE | OTHER | HP24839 | 01 | SD | HEALTHPARTNERS | OTHER | 074783100 | 05 | MN | MEDICAID | 12242 | 05 | ND | MEDICAID | 14787 | 01 | SD | MIDLANDS CHOICE | OTHER | 260040365 | 01 | SD | RR MEDICARE | OTHER | 7100902 | 05 | SD | MEDICAID | 92411422904 | 01 | MN | PRIMEWEST | OTHER | 37B91VA | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 1993774 | 05 | IA | MEDICAID | 46022474340 | 05 | NE | MEDICAID |