Organization
BOWDLE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON KOSIAK (CEO)
(605) 285-6146
Entity
Organization
Contact information
Practice address
8001 WEST 5TH STREET, BOWDLE, SD 57428-0556
(605) 285-6832
(605) 285-6986
Mailing address
P.O. BOX 556, BOWDLE, SD 57428-0556
(605) 285-6146
(605) 285-6410
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0030101
BLUE CROSS
SD
05
—
5800500
—
SD
Enumeration date
12/29/2006
Last updated
08/22/2020
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