Provider Demographics
NPI:1427014646
Name:PAUL ECKRICH MD PC
Entity Type:Organization
Organization Name:PAUL ECKRICH MD PC
Other - Org Name:ECKRICH UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ECKRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-225-7326
Mailing Address - Street 1:201 S LLOYD ST
Mailing Address - Street 2:E105
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4552
Mailing Address - Country:US
Mailing Address - Phone:605-225-7326
Mailing Address - Fax:605-229-2774
Practice Address - Street 1:201 S LLOYD ST
Practice Address - Street 2:E105
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4552
Practice Address - Country:US
Practice Address - Phone:605-225-7326
Practice Address - Fax:605-229-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0006973OtherWELLMARK BCBS OF SD
ND71105Medicare ID - Type UnspecifiedNORTH DAKOTA MEDICARE
SD0006973OtherWELLMARK BCBS OF SD
SCCG9578Medicare ID - Type UnspecifiedRAILROAD MEDICARE