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Organization
JEN MED PROF LLC
Active
Organization
JEN MED PROF LLC
Active
Other names
Sturgis Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE W. JENTER D.O. (OWNER/OPERATOR)
(605) 347-3684
Entity
Organization
Contact information
Practice address
1010 BALLPARK RD, SUITE 2, STURGIS, SD 57785-2364
(605) 347-3684
(605) 347-0083
Mailing address
1010 BALLPARK RD, SUITE 2, STURGIS, SD 57785-2364
(605) 347-3684
(605) 347-0083
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1034
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1034
PHYSICIAN'S LICENSE
SD
01
—
14172-1
FAA LICENSE NUMBER
SD
01
—
142389900
OWCP PROVIDER
SD
01
—
42339
RADIATION MEDICAL LICENSE
SD
01
—
43D0408177
CLIA LAB
SD
01
—
5602360
TITLE 19
SD
01
—
S2312
MEDICARE PTAN
SD
Enumeration date
04/06/2006
Last updated
03/07/2023
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