Provider Demographics
NPI:1235196056
Name:MCHALE INSTITUTE, P.C.
Entity Type:Organization
Organization Name:MCHALE INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:402-435-1400
Mailing Address - Street 1:3720 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108
Mailing Address - Country:US
Mailing Address - Phone:605-339-4464
Mailing Address - Fax:605-339-0309
Practice Address - Street 1:3720 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-339-4464
Practice Address - Fax:605-339-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1762207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1229OtherAVERA
SDS40331OtherPTAN
MN268R3NOOtherBLUE CROSS BLUE SHIELD
SD9203322OtherDAKOTACARE
SD0040331OtherBLUE CROSS BLUE SHIELD
SD9203322OtherDAKOTACARE
1229OtherAVERA
MN003435Medicare PIN
SD40331Medicare PIN
SDS40331OtherPTAN