Provider Demographics
NPI:1003860594
Name:GENERAL SURGERY AND DIAGNOSTICS PC
Entity Type:Organization
Organization Name:GENERAL SURGERY AND DIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-232-6353
Mailing Address - Street 1:612 N SIOUX POINT RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5088
Mailing Address - Country:US
Mailing Address - Phone:605-232-6353
Mailing Address - Fax:
Practice Address - Street 1:612 N SIOUX POINT RD
Practice Address - Street 2:SUITE 400
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5088
Practice Address - Country:US
Practice Address - Phone:605-232-6353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0271684Medicaid
IA27168Medicare ID - Type Unspecified
IA0271684Medicaid
NE099739Medicare PIN
SDA01021Medicare UPIN
SDE42097Medicare UPIN
SDP88034Medicare UPIN
SD6315Medicare ID - Type Unspecified
SDA01608Medicare UPIN