Provider Demographics
NPI:1912093881
Name:NORTH CENTRAL UROLOGY PC
Entity Type:Organization
Organization Name:NORTH CENTRAL UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-331-4493
Mailing Address - Street 1:1700 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1723
Mailing Address - Country:US
Mailing Address - Phone:605-331-4493
Mailing Address - Fax:605-331-0038
Practice Address - Street 1:1700 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1723
Practice Address - Country:US
Practice Address - Phone:605-331-4493
Practice Address - Fax:605-331-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0284208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7K9402MOtherMN BCBS JANET SMITH
IA4996954OtherIA BCBS
MN709085400Medicaid
SD0284OtherSD BOARD OF MEDICAL EXAM
SD4334139OtherAETNA
SDS40024OtherPTAN
IA0040053OtherIA BCBS JANET SMITH
MN7K939NOOtherMN BCBS
IA0989319Medicaid
SD6821984Medicaid
SD=========OtherDAKOTACARE
SDA03466Medicare UPIN
SDS40024Medicare ID - Type UnspecifiedMEDICARE NUMBER