Provider Demographics
NPI:1174689137
Name:LOIS I TRUH, MD
Entity Type:Organization
Organization Name:LOIS I TRUH, MD
Other - Org Name:LOIS I TRUH, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:ILEAN
Authorized Official - Last Name:TRUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-352-7070
Mailing Address - Street 1:807 DAKOTA AVE S
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2726
Mailing Address - Country:US
Mailing Address - Phone:605-352-7070
Mailing Address - Fax:605-352-6878
Practice Address - Street 1:807 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2726
Practice Address - Country:US
Practice Address - Phone:605-352-7070
Practice Address - Fax:605-352-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0002559OtherWELLMARK
SD02608860277OtherAMA
SD5608102Medicaid
SD3465OtherSD STATE LICENSE
SD22458OtherSIOUX VALLEY INSURANCE
SD3465OtherDAKOTACARE
SDS2559Medicare PIN