Provider Demographics
NPI:1255408977
Name:SIOUX FALLS PRIMARY CARE SERVICES PC
Entity type:Organization
Organization Name:SIOUX FALLS PRIMARY CARE SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PLUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-271-7600
Mailing Address - Street 1:3270 FOLKWAYS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1264
Mailing Address - Country:US
Mailing Address - Phone:402-435-1400
Mailing Address - Fax:402-435-1404
Practice Address - Street 1:5027 S BUR OAK PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2228
Practice Address - Country:US
Practice Address - Phone:605-271-7600
Practice Address - Fax:605-271-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9241823OtherDAKOTACARE
IA0741603Medicaid
SDDF8591OtherRAILROAD MEDICARE
SD9241823OtherDAKOTACARE