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
2501 W 22ND ST, SIOUX FALLS, SD 57105-1305
(605) 333-5399
(605) 333-5399
Mailing address
1400 W 22ND ST, SIOUX FALLS, SD 57105-1505
(605) 357-1380
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077920
BLUE CROSS AND BLUE SHIEL
SD
05
—
0788018
—
IA
05
—
5580870
—
SD
Enumeration date
04/19/2007
Last updated
10/03/2007
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