Provider Demographics
NPI:1063647154
Name:GRAHAM EAR, NOSE & THROAT P.C.
Entity Type:Organization
Organization Name:GRAHAM EAR, NOSE & THROAT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NOBLE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:605-996-8386
Mailing Address - Street 1:625 N FOSTER ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2969
Mailing Address - Country:US
Mailing Address - Phone:605-996-8386
Mailing Address - Fax:605-996-9153
Practice Address - Street 1:625 N FOSTER ST STE 203
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2969
Practice Address - Country:US
Practice Address - Phone:605-996-8386
Practice Address - Fax:605-996-9153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4248207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD20223OtherSANFORD HEALTH
SD6520252Medicaid
SD2070OtherAVERA HEALTH
SD0005047OtherBLUE CROSS BLUE SHILED
SD6520252Medicaid
SDS5047Medicare PIN