Provider Demographics
NPI:1700858248
Name:VACA, ANTHONY M (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:VACA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST.
Practice Address - Street 2:STE. 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8171
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD35982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD57108D004OtherWPS TRICARE
SD7100903Medicaid
SD0002435OtherBLUE CROSS
SD25001OtherSANFORD HEALTH PLAN
SD595989OtherARAZ/ AMERICA'S PPO
SD769191017551OtherPREFERRED ONE
MN160062OtherUCARE
SD3598OtherDAKOTACARE
SDHP24839OtherHEALTHPARTNERS
MN074783100Medicaid
ND12242Medicaid
SD14787OtherMIDLANDS CHOICE
SD260040365OtherRR MEDICARE
SD7100902Medicaid
MN92411422904OtherPRIMEWEST
MN37B91VAOtherCC SYSTEMS/ BLUE PLUS
IA1993774Medicaid
NE46022474340Medicaid
MN37B91VAOtherCC SYSTEMS/ BLUE PLUS
SD57108D004OtherWPS TRICARE
SD7100903Medicaid
SDS3846Medicare PIN