Organization
USC AMBULATORY SURGICAL CENTER PROF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMI GRONSETH (PRACTICE ADMINISTRATOR)
(605) 336-0635
Entity
Organization
Contact information
Practice address
201 WEST 69TH STREET, SIOUX FALLS, SD 57108-2424
(605) 336-0635
Mailing address
201 WEST 69TH STREET, SIOUX FALLS, SD 57108-2424
(605) 336-0635
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518129576
BLUE SHIELD OF MN
MN
01
—
1518129576
BCBS
SD
05
—
1518129576
—
IA
05
—
1518129576
—
MN
05
—
5490500
—
SD
01
—
P00729337
RAILROAD MEDICARE
—
Enumeration date
06/30/2008
Last updated
08/25/2009
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