Provider Demographics
NPI:1609955939
Name:MEDICAL ASSOCIATES CLINIC SURGERY CENTER
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES CLINIC SURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:K
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-945-5214
Mailing Address - Street 1:100 MAC LANE
Mailing Address - Street 2:P. O. BOX 758
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-0758
Mailing Address - Country:US
Mailing Address - Phone:605-945-5210
Mailing Address - Fax:605-945-3244
Practice Address - Street 1:100 MAC LANE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-0758
Practice Address - Country:US
Practice Address - Phone:605-945-5210
Practice Address - Fax:605-945-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11146261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS43007Medicare PIN
SD0314860001Medicare NSC