Provider Demographics
NPI:1972506939
Name:DAKOTA SURGICAL LTD
Entity Type:Organization
Organization Name:DAKOTA SURGICAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS, FACS
Authorized Official - Phone:605-334-2266
Mailing Address - Street 1:911 E 20TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1045
Mailing Address - Country:US
Mailing Address - Phone:605-334-2266
Mailing Address - Fax:605-322-7675
Practice Address - Street 1:911 E 20TH ST
Practice Address - Street 2:STE 300
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1045
Practice Address - Country:US
Practice Address - Phone:605-334-2266
Practice Address - Fax:605-322-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD40865261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS40864Medicare PIN