Provider Demographics
NPI:1619394491
Name:GEORGE A. NICHOLAS, M.D.
Entity Type:Organization
Organization Name:GEORGE A. NICHOLAS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEV
Authorized Official - Middle Name:
Authorized Official - Last Name:TSCHETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-352-7711
Mailing Address - Street 1:530 IOWA AVE SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 IOWA AVE SE
Practice Address - Street 2:SUITE 106
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2864
Practice Address - Country:US
Practice Address - Phone:605-352-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5603630Medicaid
SD5603630Medicaid
SDS6002Medicare PIN