Provider Demographics
NPI:1124352018
Name:KATHRYN A BARRETT MD PC
Entity type:Organization
Organization Name:KATHRYN A BARRETT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-718-5566
Mailing Address - Street 1:740 SHERIDAN LAKE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0900
Mailing Address - Country:US
Mailing Address - Phone:605-718-5566
Mailing Address - Fax:605-718-5568
Practice Address - Street 1:740 SHERIDAN LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0900
Practice Address - Country:US
Practice Address - Phone:605-718-5566
Practice Address - Fax:605-718-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDE92196Medicare UPIN