Organization
WEBER MEDICAL SERVICES PC
Active
Other names
Main Street Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE M WEBER PA C (OWNER)
(605) 685-1450
Entity
Organization
Contact information
Practice address
109 PUGH STREET, MARTIN, SD 57551-0370
(605) 685-1450
(605) 685-1453
Mailing address
PO BOX 370, MARTIN, SD 57551-0370
(605) 685-1450
(605) 685-1453
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0304
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4994699
WELLMARK
SD
05
—
5300880
—
SD
Enumeration date
11/29/2006
Last updated
10/01/2008
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