Provider Demographics
NPI:1790225266
Name:STORM CLINIC, PROF. LLC
Entity Type:Organization
Organization Name:STORM CLINIC, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:605-271-5441
Mailing Address - Street 1:7000 S LYNCREST PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2599
Mailing Address - Country:US
Mailing Address - Phone:605-271-5441
Mailing Address - Fax:605-271-5277
Practice Address - Street 1:7000 S LYNCREST PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2599
Practice Address - Country:US
Practice Address - Phone:605-271-5441
Practice Address - Fax:605-271-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty