Provider Demographics
NPI:1992153225
Name:QVIDITY, LLC
Entity type:Organization
Organization Name:QVIDITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:605-721-9935
Mailing Address - Street 1:1935 SAMCO RD
Mailing Address - Street 2:STE 106
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-6223
Mailing Address - Country:US
Mailing Address - Phone:605-721-9935
Mailing Address - Fax:605-718-0769
Practice Address - Street 1:1935 SAMCO RD
Practice Address - Street 2:STE 106
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-6223
Practice Address - Country:US
Practice Address - Phone:605-721-9935
Practice Address - Fax:605-718-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service