Basic Information
| Provider Information | |||||||||
| NPI: | 1952339343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARNETT | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86430 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053224900 | ||||||||
| FaxNumber: | 6053224910 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 S HILL ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570588760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054252855 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 04/15/2010 | ||||||||
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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 | 363A00000X | 0067 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 0067 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | P00294626 | 01 | RAILROAD MEDICARE | OTHER | 6828002 | 05 | SD | MEDICAID |