Provider Demographics
NPI:1801896584
Name:VANOVERBEKE, TROY D (PA)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:D
Last Name:VANOVERBEKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-9556
Mailing Address - Fax:605-328-9501
Practice Address - Street 1:905 NORTH OAKS AVENUE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033
Practice Address - Country:US
Practice Address - Phone:605-528-3725
Practice Address - Fax:605-528-3741
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD0523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6824395Medicaid
SDS41064Medicare PIN
SD970030009Medicare PIN
SDP80289Medicare UPIN
SD6824395Medicaid
SD970030000Medicare PIN