Provider Demographics
NPI:1912927831
Name:ONIDA AREA DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:ONIDA AREA DEVELOPMENT CORPORATION
Other - Org Name:COMMUNITY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARVEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:605-258-2747
Mailing Address - Street 1:1601 N HARRISON AVE
Mailing Address - Street 2:STE # 1B
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2378
Mailing Address - Country:US
Mailing Address - Phone:605-945-1371
Mailing Address - Fax:605-945-3237
Practice Address - Street 1:1601 N HARRISON AVE
Practice Address - Street 2:STE # 1B
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2378
Practice Address - Country:US
Practice Address - Phone:605-258-2747
Practice Address - Fax:605-258-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD100582Medicare ID - Type UnspecifiedGROUP