Provider Demographics
NPI:1629044458
Name:JACOBS, TAD (DO)
Entity Type:Individual
Prefix:MR
First Name:TAD
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-1217
Mailing Address - Country:US
Mailing Address - Phone:605-428-5446
Mailing Address - Fax:605-428-2333
Practice Address - Street 1:111 E 10TH ST
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1217
Practice Address - Country:US
Practice Address - Phone:605-997-2471
Practice Address - Fax:605-997-2418
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD57028A004OtherWPS TRICARE
SD1258OtherDAKOTACARE
MN873765700Medicaid
SD12967OtherMIDLANDS CHOICE
SD68890OtherARAZ/AMERICA'S PPO
SDAH908107523OtherPREFERRED ONE
SD5602007Medicaid
SD4995979OtherBCBS OF SOUTH DAKOTA
MN659S6JAOtherBCBS OF MN
MN659S 6JAOtherCC SYSTEMS BLUE PLUS
SD5602006Medicaid
SD12967OtherMIDLANDS CHOICE
SDD25374Medicare UPIN
SD5602006Medicaid