Provider Demographics
NPI:1174598437
Name:FARRELL PC
Entity type:Organization
Organization Name:FARRELL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-232-9231
Mailing Address - Street 1:612 N SIOUX POINT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5078
Mailing Address - Country:US
Mailing Address - Phone:605-232-9231
Mailing Address - Fax:605-232-9259
Practice Address - Street 1:612 N SIOUX POINT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5078
Practice Address - Country:US
Practice Address - Phone:605-232-9231
Practice Address - Fax:605-232-9259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS4739Medicare PIN