Provider Demographics
NPI:1053446443
Name:BETH BRUENING PC
Entity Type:Organization
Organization Name:BETH BRUENING PC
Other - Org Name:BRUENING EYE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-217-4500
Mailing Address - Street 1:PO BOX 3566
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-3566
Mailing Address - Country:US
Mailing Address - Phone:605-217-4500
Mailing Address - Fax:
Practice Address - Street 1:101 TOWER ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049
Practice Address - Country:US
Practice Address - Phone:605-217-4500
Practice Address - Fax:605-217-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD650152W00000X
IA28135174400000X
SD3577207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025498700Medicaid
SD7760323Medicaid
IA2072876Medicaid
NE10025636300Medicaid
SD3577OtherSD LIC
IA28135OtherIA LIC
IAI19538Medicare PIN
NE10025498700Medicaid
IA2072876Medicaid
IAF01422Medicare UPIN
DF6013Medicare PIN