Provider Demographics
NPI:1760569248
Name:SURGICAL INSTITUTE OF SOUTH DAKOTA, PC
Entity Type:Organization
Organization Name:SURGICAL INSTITUTE OF SOUTH DAKOTA, PC
Other - Org Name:SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HATTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-334-0393
Mailing Address - Street 1:911 E. 20TH ST.
Mailing Address - Street 2:STE. 700
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1049
Mailing Address - Country:US
Mailing Address - Phone:605-334-0393
Mailing Address - Fax:605-334-6028
Practice Address - Street 1:911 E. 20TH ST.
Practice Address - Street 2:STE. 700
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1049
Practice Address - Country:US
Practice Address - Phone:605-334-0393
Practice Address - Fax:605-334-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN93075DAOtherBLUE SHIELD GROUP NUMBER
SD0002428OtherBLUE SHIELD GROUP NUMBER
MNC02744Medicare ID - Type UnspecifiedGROUP NUMBER
SD2428Medicare ID - Type UnspecifiedGROUP NUMBER
MN166618500Medicaid