Provider Demographics
NPI:1386620607
Name:GPPS LLC
Entity type:Organization
Organization Name:GPPS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PRIBYL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:605-323-2345
Mailing Address - Street 1:4105 S CARNEGIE PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2360
Mailing Address - Country:US
Mailing Address - Phone:605-323-2345
Mailing Address - Fax:605-323-2822
Practice Address - Street 1:4105 S CARNEGIE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2360
Practice Address - Country:US
Practice Address - Phone:605-323-2345
Practice Address - Fax:605-323-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2553Medicare ID - Type Unspecified