Provider Demographics
NPI:1134302177
Name:CITY OF SIOUX FALLS
Entity Type:Organization
Organization Name:CITY OF SIOUX FALLS
Other - Org Name:CITY OF SIOUX FALLS HEALTH DEPT. LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-367-8760
Mailing Address - Street 1:521 N. MAIN AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5947
Mailing Address - Country:US
Mailing Address - Phone:605-367-8777
Mailing Address - Fax:605-367-8645
Practice Address - Street 1:521 N. MAIN AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5947
Practice Address - Country:US
Practice Address - Phone:605-367-8777
Practice Address - Fax:605-367-8645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF SIOUX FALLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4760Medicare PIN