Provider Demographics
NPI:1497403646
Name:PURE HEALTHCARE OF SOUTH DAKOTA LLC
Entity Type:Organization
Organization Name:PURE HEALTHCARE OF SOUTH DAKOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:T
Authorized Official - Last Name:TANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-590-9267
Mailing Address - Street 1:4179 S RIVERBOAT RD STE 220
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2986
Mailing Address - Country:US
Mailing Address - Phone:801-590-9267
Mailing Address - Fax:
Practice Address - Street 1:25 1ST AVE SW STE A
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-3507
Practice Address - Country:US
Practice Address - Phone:801-590-9267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty