Provider Demographics
NPI:1518011881
Name:YANKTON RADIOLOGY PROF LLC
Entity Type:Organization
Organization Name:YANKTON RADIOLOGY PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-9511
Mailing Address - Street 1:314 WALNUT ST
Mailing Address - Street 2:PO BOX 650
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4374
Mailing Address - Country:US
Mailing Address - Phone:605-665-9511
Mailing Address - Fax:605-665-4253
Practice Address - Street 1:314 WALNUT ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4374
Practice Address - Country:US
Practice Address - Phone:605-665-9511
Practice Address - Fax:605-665-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S100660Medicare PIN