Organization
JEN MED PROF LLC
Active
Other names
Sturgis Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE W. JENTER D.O. (OWNER/OPERATOR)
(605) 347-3684
Entity
Organization
Contact information
Practice address
1010 BALLPARK RD, SUITE 2, STURGIS, SD 57785-2364
(605) 347-3684
(605) 347-0083
Mailing address
1010 BALLPARK RD, SUITE 2, STURGIS, SD 57785-2364
(605) 347-3684
(605) 347-0083
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1034
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1034
PHYSICIAN'S LICENSE
SD
01
—
14172-1
FAA LICENSE NUMBER
SD
01
—
142389900
OWCP PROVIDER
SD
01
—
42339
RADIATION MEDICAL LICENSE
SD
01
—
43D0408177
CLIA LAB
SD
01
—
5602360
TITLE 19
SD
01
—
S2312
MEDICARE PTAN
SD
Enumeration date
04/06/2006
Last updated
03/07/2023
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