Basic Information
| Provider Information | |||||||||
| NPI: | 1760569248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL INSTITUTE OF SOUTH DAKOTA, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SURGICAL INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 E. 20TH ST. | ||||||||
| Address2: | STE. 700 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053340393 | ||||||||
| FaxNumber: | 6053346028 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 E. 20TH ST. | ||||||||
| Address2: | STE. 700 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053340393 | ||||||||
| FaxNumber: | 6053346028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 10/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | HATTING | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6053340393 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.