Provider Demographics
NPI:1912076100
Name:SIOUX FALLS CARDIOVASCULAR PC
Entity Type:Organization
Organization Name:SIOUX FALLS CARDIOVASCULAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VASKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-274-6300
Mailing Address - Street 1:6709 S MINNESOTA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2593
Mailing Address - Country:US
Mailing Address - Phone:605-274-6300
Mailing Address - Fax:877-616-4723
Practice Address - Street 1:6709 S MINNESOTA AVE STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2593
Practice Address - Country:US
Practice Address - Phone:605-274-6300
Practice Address - Fax:877-616-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0742882Medicaid
DF6275OtherRAILROAD MEDICARE
DF6275OtherRAILROAD MEDICARE
IA0742882Medicaid