Provider Demographics
NPI:1073009916
Name:DV SURGICAL
Entity type:Organization
Organization Name:DV SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SCHIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-230-0305
Mailing Address - Street 1:451 E SAWGRASS TRL
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5269
Mailing Address - Country:US
Mailing Address - Phone:712-230-0305
Mailing Address - Fax:
Practice Address - Street 1:1317 RIVER DR
Practice Address - Street 2:
Practice Address - City:NORTH SIOUX CITY
Practice Address - State:SD
Practice Address - Zip Code:57049-3015
Practice Address - Country:US
Practice Address - Phone:712-230-0305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD=========OtherBLUE CROSS BLUE SHIELD
SD=========Medicaid