Provider Demographics
NPI:1790937472
Name:CITY OF REDFIELD
Entity Type:Organization
Organization Name:CITY OF REDFIELD
Other - Org Name:DOLAND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SJURSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-472-1110
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:DOLAND
Mailing Address - State:SD
Mailing Address - Zip Code:57436
Mailing Address - Country:US
Mailing Address - Phone:605-635-6300
Mailing Address - Fax:605-635-6402
Practice Address - Street 1:213 N. HUMPHREY
Practice Address - Street 2:
Practice Address - City:DOLAND
Practice Address - State:SD
Practice Address - Zip Code:57436
Practice Address - Country:US
Practice Address - Phone:605-635-6300
Practice Address - Fax:605-635-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD433404Medicare Oscar/Certification
SDS2712Medicare PIN