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Organization
USC AMBULATORY SURGICAL CENTER PROF LLC
Active
Organization
USC AMBULATORY SURGICAL CENTER PROF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMI GRONSETH (PRACTICE ADMINISTRATOR)
(605) 336-0635
Entity
Organization
Contact information
Practice address
201 WEST 69TH STREET, SIOUX FALLS, SD 57108-2424
(605) 336-0635
Mailing address
201 WEST 69TH STREET, SIOUX FALLS, SD 57108-2424
(605) 336-0635
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518129576
BLUE SHIELD OF MN
MN
01
—
1518129576
BCBS
SD
05
—
1518129576
—
IA
05
—
1518129576
—
MN
05
—
5490500
—
SD
01
—
P00729337
RAILROAD MEDICARE
—
Enumeration date
06/30/2008
Last updated
08/25/2009
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