Provider Demographics
NPI:1972751766
Name:ARLINGTON MEDICAL CLINIC
Entity type:Organization
Organization Name:ARLINGTON MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:REDFISH
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:605-983-3283
Mailing Address - Street 1:104 W. BIRCH ST
Mailing Address - Street 2:PO BOX 291
Mailing Address - City:ARLINGTON
Mailing Address - State:SD
Mailing Address - Zip Code:57212
Mailing Address - Country:US
Mailing Address - Phone:605-983-3293
Mailing Address - Fax:605-983-5112
Practice Address - Street 1:104 W. BIRCH
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:SD
Practice Address - Zip Code:57212
Practice Address - Country:US
Practice Address - Phone:605-983-3293
Practice Address - Fax:605-983-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0173302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5300830Medicaid
SD433842Medicare PIN