Provider Demographics
NPI:1952488371
Name:MARK BELYEA MD PC
Entity type:Organization
Organization Name:MARK BELYEA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:BELYEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-352-6040
Mailing Address - Street 1:118 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2502
Mailing Address - Country:US
Mailing Address - Phone:605-352-6040
Mailing Address - Fax:
Practice Address - Street 1:118 3RD ST SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2502
Practice Address - Country:US
Practice Address - Phone:605-352-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0299261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5602352Medicaid
SDD25159Medicare UPIN
SD5602352Medicaid