Basic Information
| Provider Information | |||||||||
| NPI: | 1952384216 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUNES MEDICAL LABORATORIES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MERCYONE DAKOTA DUNES MEDICAL LABORATORIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1463 | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511021463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122792263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 TOWER RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052324270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | FLANNERY-HUGHES | ||||||||
| AuthorizedOfficialFirstName: | M. ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7122792018 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 5581310 | 05 | SD | MEDICAID | 0508259 | 05 | IA | MEDICAID | 0005376 | 01 | SD | WELLMARK SD BLUE SHILED | OTHER |