Provider Demographics
NPI:1710937685
Name:NUCLEAR DIAGNOSIS, L.L.C.
Entity Type:Organization
Organization Name:NUCLEAR DIAGNOSIS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHAEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-717-4447
Mailing Address - Street 1:3103 E FAIRGROUNDS LOOP
Mailing Address - Street 2:P O BOX 189
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-6049
Mailing Address - Country:US
Mailing Address - Phone:605-717-4447
Mailing Address - Fax:605-717-4449
Practice Address - Street 1:3103 E FAIRGROUNDS LOOP
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-6049
Practice Address - Country:US
Practice Address - Phone:605-717-4447
Practice Address - Fax:605-717-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7290230Medicaid
SD7290230Medicaid