Organization
UNIVERSITY PHYSICIAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TORY PAYNE (EXECUTIVE DIRECTOR)
(605) 782-2131
Entity
Organization
Contact information
Practice address
1310 W 22ND ST, SIOUX FALLS, SD 57105-1501
(605) 782-2000
(605) 782-2721
Mailing address
PO BOX 89208, SIOUX FALLS, SD 57109-9208
(605) 782-2000
(605) 782-2721
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CU0716
RAILROAD MEDICARE
SD
Enumeration date
06/23/2006
Last updated
09/04/2007
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