Provider Demographics
NPI:1609809094
Name:MEEHAN, PHILLIP E (PA)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:E
Last Name:MEEHAN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:2400 S. MINNESOTA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1301 S. CLIFF AVE
Practice Address - Street 2:STE 610
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-8860
Practice Address - Fax:605-322-8868
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-12-18
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Provider Licenses
StateLicense IDTaxonomies
SD0571363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025568900Medicaid
IA1821021304Medicaid
SD9238709OtherDAKOTACARE
MN46L92MEOtherCC SYSTEMS/ BLUE PLUS
SD4992676OtherBLUE CROSS
SD1609809094OtherARAZ/ AMERICA'S PPO
SD248340OtherMIDLANDS CHOICE
SD0127834OtherMEDICA
SD248340OtherMIDLAND'S CHOICE
SD6827152Medicaid
SDC83141041559OtherPREFERRED ONE
SD57105AT04OtherWPS TRICARE
SD248340OtherMIDLAND'S CHOICE
NE10025568900Medicaid