Provider Demographics
NPI:1083992010
Name:NATHAN H LOEWEN
Entity Type:Organization
Organization Name:NATHAN H LOEWEN
Other - Org Name:NEW LIFE FAMILY MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-352-2117
Mailing Address - Street 1:118 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2502
Mailing Address - Country:US
Mailing Address - Phone:605-352-2117
Mailing Address - Fax:605-554-2200
Practice Address - Street 1:118 3RD ST SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2502
Practice Address - Country:US
Practice Address - Phone:605-352-2117
Practice Address - Fax:605-554-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDB91230Medicare UPIN