Provider Demographics
NPI:1952384216
Name:DUNES MEDICAL LABORATORIES
Entity type:Organization
Organization Name:DUNES MEDICAL LABORATORIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JESICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-5850
Mailing Address - Street 1:PO BOX 1463
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-1463
Mailing Address - Country:US
Mailing Address - Phone:712-279-2263
Mailing Address - Fax:
Practice Address - Street 1:101 TOWER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049
Practice Address - Country:US
Practice Address - Phone:605-232-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0508259Medicaid
SD5581310Medicaid
SD0005376OtherWELLMARK SD BLUE SHILED
SD5376Medicare ID - Type Unspecified
SD0005376OtherWELLMARK SD BLUE SHILED
SD0005376OtherWELLMARK SD BLUE SHILED
NE=========00Medicaid