Provider Demographics
NPI:1104201599
Name:SIOUX FALLS CENTER FOR PLASTIC AND RECONSTRUCTIVE SURGERY
Entity Type:Organization
Organization Name:SIOUX FALLS CENTER FOR PLASTIC AND RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-334-1930
Mailing Address - Street 1:6301 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2528
Mailing Address - Country:US
Mailing Address - Phone:605-334-1930
Mailing Address - Fax:605-334-0926
Practice Address - Street 1:6301 S MINNESOTA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2528
Practice Address - Country:US
Practice Address - Phone:605-334-1930
Practice Address - Fax:605-334-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center