Provider Demographics
NPI:1285748467
Name:DAKOTA CARDIOVASCULAR, P.C.
Entity type:Organization
Organization Name:DAKOTA CARDIOVASCULAR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN-WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-341-1300
Mailing Address - Street 1:343 QUINCY ST
Mailing Address - Street 2:#104
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3700
Mailing Address - Country:US
Mailing Address - Phone:605-341-1300
Mailing Address - Fax:605-341-8785
Practice Address - Street 1:343 QUINCY ST
Practice Address - Street 2:#104
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3700
Practice Address - Country:US
Practice Address - Phone:605-341-1300
Practice Address - Fax:605-341-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS4667Medicare PIN