Provider Demographics
NPI:1760487664
Name:DAKOTA PLAINS CLINIC, LLP
Entity Type:Organization
Organization Name:DAKOTA PLAINS CLINIC, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-224-2010
Mailing Address - Street 1:640 E SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3300
Mailing Address - Country:US
Mailing Address - Phone:605-224-2010
Mailing Address - Fax:605-224-0369
Practice Address - Street 1:640 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3300
Practice Address - Country:US
Practice Address - Phone:605-224-2010
Practice Address - Fax:605-224-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4995174OtherBLUE CROSS
SD4995174OtherBLUE CROSS
SD4995174OtherBLUE CROSS