Provider Demographics
NPI:1447343827
Name:DAKOTA WEST RADIATION ONCOLOGY PC
Entity type:Organization
Organization Name:DAKOTA WEST RADIATION ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:STENER
Authorized Official - Last Name:EASTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-719-8559
Mailing Address - Street 1:PO BOX 8010
Mailing Address - Street 2:353 FAIRMONT BLVD
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-719-8559
Mailing Address - Fax:605-719-2310
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-719-8559
Practice Address - Fax:605-719-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0002528OtherBLUE CROSS BLUE SHIELD
C04620OtherRAILROAD MEDICARE
SDS6509Medicare ID - Type Unspecified