Provider Demographics
NPI:1780730820
Name:MIDWEST DIAGNOSTICS P.C.
Entity type:Organization
Organization Name:MIDWEST DIAGNOSTICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-331-0537
Mailing Address - Street 1:PO BOX 1756
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57101-1756
Mailing Address - Country:US
Mailing Address - Phone:605-331-0537
Mailing Address - Fax:
Practice Address - Street 1:412 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6901
Practice Address - Country:US
Practice Address - Phone:605-331-0537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD246R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyGroup - Single Specialty