Provider Demographics
NPI:1295936243
Name:JAMES MATHEW WEEKLY MD PC
Entity type:Organization
Organization Name:JAMES MATHEW WEEKLY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:WEEKLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-225-1420
Mailing Address - Street 1:201 S LLOYD ST
Mailing Address - Street 2:SUITE E106
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4552
Mailing Address - Country:US
Mailing Address - Phone:605-225-1420
Mailing Address - Fax:605-225-3307
Practice Address - Street 1:201 S LLOYD ST
Practice Address - Street 2:SUITE E106
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4552
Practice Address - Country:US
Practice Address - Phone:605-225-1420
Practice Address - Fax:605-225-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0371207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0008451OtherBCBS
ND10423Medicaid
SD6520262Medicaid
SD0008451OtherBCBS
SD6520262Medicaid
SDS8189Medicare PIN