Provider Demographics
NPI:1871592030
Name:DAKOTA PLAINS SURGICAL LLP
Entity type:Organization
Organization Name:DAKOTA PLAINS SURGICAL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:605-226-9706
Mailing Address - Street 1:701 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1803
Mailing Address - Country:US
Mailing Address - Phone:605-225-3300
Mailing Address - Fax:605-225-3877
Practice Address - Street 1:701 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1803
Practice Address - Country:US
Practice Address - Phone:605-225-3300
Practice Address - Fax:605-225-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10584284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
142543900OtherUS DEPT OF LABOR
SD5508040Medicaid
060227009OtherPRIMEWEST
SD0108040Medicaid
57401OtherTRICARE WEST
6800078OtherMEDICA
771940OtherARAZ
ND1383Medicaid
21388OtherSANFORD HEALTH PLAN
SD80092OtherBLUE CROSS
SD5508040Medicaid
6800078OtherMEDICA
SD80092OtherBLUE CROSS
=========OtherDAKOTACARE
=========001OtherCHAMPUS
=========OtherDAKOTACARE