Provider Demographics
NPI:1740204221
Name:STATE OF SOUTH DAKOTA DIVISION OF OASI
Entity Type:Organization
Organization Name:STATE OF SOUTH DAKOTA DIVISION OF OASI
Other - Org Name:SOUTH DAKOTA DEPARTMENT OF HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WEISBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-773-4939
Mailing Address - Street 1:600 E CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2536
Mailing Address - Country:US
Mailing Address - Phone:605-773-3361
Mailing Address - Fax:605-773-5683
Practice Address - Street 1:600 E CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2536
Practice Address - Country:US
Practice Address - Phone:605-773-4074
Practice Address - Fax:605-773-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5100010Medicaid