Provider Demographics
NPI:1295732709
Name:SLABA, TRAVIS J (PA-C)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:J
Last Name:SLABA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0900
Mailing Address - Country:US
Mailing Address - Phone:605-504-5400
Mailing Address - Fax:605-504-5150
Practice Address - Street 1:220 S CLIFF AVE STE 120
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-2117
Practice Address - Country:US
Practice Address - Phone:605-213-8000
Practice Address - Fax:605-213-8005
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0541363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6824970Medicaid