# BOWDLE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982760435
- **Authorized official:** MR. JON KOSIAK (CEO)
- **Authorized official phone:** (605) 285-6146

## Contact information

- **Practice address:** 8001 WEST 5TH STREET, BOWDLE, SD 57428-0556
- **Practice address phone:** (605) 285-6832
- **Practice address fax:** (605) 285-6986
- **Mailing address:** P.O. BOX 556, BOWDLE, SD 57428-0556
- **Mailing address phone:** (605) 285-6146
- **Mailing address fax:** (605) 285-6410

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/29/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0030101 | BLUE CROSS | SD |
| 05 | — | 5800500 | — | SD |