Provider Demographics
NPI:1962598029
Name:MITCHELL BONE AND JOINT SURGERY
Entity type:Organization
Organization Name:MITCHELL BONE AND JOINT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:FLORES
Authorized Official - Last Name:UNGACTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-996-1800
Mailing Address - Street 1:625 N FOSTER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2969
Mailing Address - Country:US
Mailing Address - Phone:605-996-1800
Mailing Address - Fax:605-996-7272
Practice Address - Street 1:625 N FOSTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2969
Practice Address - Country:US
Practice Address - Phone:605-996-1800
Practice Address - Fax:605-996-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4899207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6402082Medicaid
SD6402082Medicaid
SD8337Medicare ID - Type Unspecified