Provider Demographics
NPI:1093792244
Name:CJ ELMWOOD PARTNERS L P
Entity Type:Organization
Organization Name:CJ ELMWOOD PARTNERS L P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-239-3937
Mailing Address - Street 1:3801 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6565
Mailing Address - Country:US
Mailing Address - Phone:800-338-2015
Mailing Address - Fax:605-334-0737
Practice Address - Street 1:3801 S ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6565
Practice Address - Country:US
Practice Address - Phone:800-338-2015
Practice Address - Fax:605-334-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11147261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0562686Medicaid
SD5490074Medicaid
MN462443200Medicaid
IA0562686Medicaid