Provider Demographics
NPI:1306962162
Name:YANKTON MEDICAL CLINIC PC
Entity type:Organization
Organization Name:YANKTON MEDICAL CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-7841
Mailing Address - Street 1:101 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3306
Mailing Address - Country:US
Mailing Address - Phone:605-624-8643
Mailing Address - Fax:
Practice Address - Street 1:101 S PLUM ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3306
Practice Address - Country:US
Practice Address - Phone:605-624-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YANKTON MEDICAL CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty