Basic Information
| Provider Information | |||||||||
| NPI: | 1760487664 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAKOTA PLAINS CLINIC, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 E SIOUX AVE | ||||||||
| Address2: | |||||||||
| City: | PIERRE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 575013300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052242010 | ||||||||
| FaxNumber: | 6052240369 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 E SIOUX AVE | ||||||||
| Address2: | |||||||||
| City: | PIERRE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 575013300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052242010 | ||||||||
| FaxNumber: | 6052240369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AUSTAD | ||||||||
| AuthorizedOfficialFirstName: | ALLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6052242010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4995174 | 01 | SD | BLUE CROSS | OTHER |