Provider Demographics
NPI:1578988804
Name:SMART MEDICAL CLINIC
Entity Type:Organization
Organization Name:SMART MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATIZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:605-251-1154
Mailing Address - Street 1:1905 W 57TH ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2893
Mailing Address - Country:US
Mailing Address - Phone:605-310-2000
Mailing Address - Fax:
Practice Address - Street 1:1905 W 57TH ST
Practice Address - Street 2:STE 1A
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2893
Practice Address - Country:US
Practice Address - Phone:605-310-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center