Provider Demographics
NPI: | 1447251350 |
---|---|
Name: | YANKTON MEDICAL CLINIC PC |
Entity type: | Organization |
Organization Name: | YANKTON MEDICAL CLINIC PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BECKY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MCMANUS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 605-665-7841 |
Mailing Address - Street 1: | 1104 W 8TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | YANKTON |
Mailing Address - State: | SD |
Mailing Address - Zip Code: | 57078-3306 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 605-665-7841 |
Mailing Address - Fax: | 605-665-0546 |
Practice Address - Street 1: | 1104 W 8TH ST |
Practice Address - Street 2: | |
Practice Address - City: | YANKTON |
Practice Address - State: | SD |
Practice Address - Zip Code: | 57078-3306 |
Practice Address - Country: | US |
Practice Address - Phone: | 605-665-7841 |
Practice Address - Fax: | 605-665-0546 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-08-02 |
Last Update Date: | 2025-02-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 237600000X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SD | CR0198 | Other | RAILROAD MEDICARE |
SD | S13 | Medicare PIN | |
SD | 0605720001 | Medicare NSC | |
NE | 098918 | Medicare PIN |