Provider Demographics
NPI:1396383329
Name:LMMC SIOUX FALLS, LLC
Entity Type:Organization
Organization Name:LMMC SIOUX FALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORVATICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-614-4969
Mailing Address - Street 1:2255 S 132ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2573
Mailing Address - Country:US
Mailing Address - Phone:402-614-4969
Mailing Address - Fax:402-614-4416
Practice Address - Street 1:5919 S REMINGTON PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5143
Practice Address - Country:US
Practice Address - Phone:402-614-4969
Practice Address - Fax:402-614-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty