Organization
PRAIRIE STATES SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN M CARLEY (ADMINISTRATOR)
(605) 336-2638
Entity
Organization
Contact information
Practice address
2908 E 26TH ST STE B, SIOUX FALLS, SD 57103-4034
(605) 336-2638
(605) 334-3500
Mailing address
2908 E 26TH ST STE B, SIOUX FALLS, SD 57103-4034
(605) 336-2638
(605) 334-3500
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
47078
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0550558
—
IA
05
—
5490300
—
SD
01
—
7Y49PR
BLUE CROSS
MN
01
—
81017
BLUE CROSS
SD
05
—
826730800
—
MN
Enumeration date
05/16/2006
Last updated
04/29/2010
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