Organization
SANFORD SCHOOL OF MEDICINE OF THE UNIVERSITY OF SOUTH DAKOTA CLINICAL
Active
Organization
SANFORD SCHOOL OF MEDICINE OF THE UNIVERSITY OF SOUTH DAKOTA CLINICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R KOCH M. D. (DEPT. CHAIR)
(605) 336-3230
Entity
Organization
Contact information
Practice address
353 FAIRMONT BLVD, RAPID CITY, SD 57701-7375
(605) 394-5143
Mailing address
1400 W 22ND ST, SIOUX FALLS, SD 57105-1505
(605) 357-1380
(605) 357-1548
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077925
BLUE CROSS AND BLUE SHIEL
SD
05
—
5580872
—
SD
Enumeration date
04/19/2007
Last updated
10/04/2007
Update your record
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