Provider Demographics
NPI:1588671598
Name:WEST, JUDY MARIE
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:MARIE
Last Name:WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:MARIE
Other - Last Name:SATTERLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 SW BLAINE STREET
Mailing Address - Street 2:
Mailing Address - City:HIGHMORE
Mailing Address - State:SD
Mailing Address - Zip Code:57345
Mailing Address - Country:US
Mailing Address - Phone:605-852-3267
Mailing Address - Fax:
Practice Address - Street 1:HWY 34 & 47
Practice Address - Street 2:
Practice Address - City:FORT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339-0200
Practice Address - Country:US
Practice Address - Phone:605-245-2285
Practice Address - Fax:605-245-2384
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471C3401X, 2471S1302X
SD693422471C3402X, 2471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Not Answered2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5549010Medicaid