Provider Demographics
NPI:1902017825
Name:JONATHAN C. OLEGARIO, MD, PC
Entity Type:Organization
Organization Name:JONATHAN C. OLEGARIO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CACERES
Authorized Official - Last Name:OLEGARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-996-9141
Mailing Address - Street 1:120 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1920
Mailing Address - Country:US
Mailing Address - Phone:605-996-9141
Mailing Address - Fax:605-996-9194
Practice Address - Street 1:120 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1920
Practice Address - Country:US
Practice Address - Phone:605-996-9141
Practice Address - Fax:605-996-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6005240Medicaid
SD6005240Medicaid
SD100550Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
SDI42391Medicare UPIN