| Dr Scott James Keckler, MD | |
|
1600 W 22nd St, Sioux Falls, SD 57105-1521 | |
| (605) 312-1000 | |
| (605) 312-1001 |
| Full Name | Dr Scott James Keckler |
|---|---|
| Gender | Male |
| Speciality | Surgery - Pediatric Surgery |
| Location | 1600 W 22nd St, Sioux Falls, South Dakota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154597011 | NPI | - | NPPES |
| 431560263 | Other | MO | TRICARE |
| 193951001 | Medicaid | AR | |
| P01089889 | Other | MO | RR MCR |
| 1154597011 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 2012024116 (Missouri) | Secondary |
| 2086S0120X | Surgery - Pediatric Surgery | 11615 (South Dakota) | Primary |
| Entity Name | Sanford Clinic |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1396764254 PECOS PAC ID: 0244143824 Enrollment ID: O20031110000532 |
| Entity Name | Sanford Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093090342 PECOS PAC ID: 8325950215 Enrollment ID: O20040115000388 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Scott James Keckler, MD Po Box 2580, Springfield, MO 65801-2580 Ph: (417) 829-4620 | Dr Scott James Keckler, MD 1600 W 22nd St, Sioux Falls, SD 57105-1521 Ph: (605) 312-1000 |
Mark Shashikant, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 6215 South Cliff Avenue, Sioux Falls, SD 57108 Phone: 605-322-4130 Fax: 605-322-4131 | |
Dennis Glatt, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1201 S Euclid Ave, Ste 104, Sioux Falls, SD 57105 Phone: 605-328-3840 Fax: 605-328-3841 | |
Bradley Clark Thaemert, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 911 E 20th St, Ste 700, Sioux Falls, SD 57105 Phone: 605-334-0393 Fax: 605-334-6028 | |
Dr. Patrick Wayne Kelly, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 3801 S Elmwood Ave, Sioux Falls, SD 57105 Phone: 605-306-6140 Fax: 605-306-6500 | |
Kirke Wheeler, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1201 S Euclid Ave, Ste 104, Sioux Falls, SD 57105 Phone: 605-328-3840 Fax: 605-328-3841 | |
Gregory Kent Nissen, Surgery Medicare: Accepting Medicare Assignments Practice Location: 3801 S Elmwood Ave, Sioux Falls, SD 57105 Phone: 605-306-6140 Fax: 605-306-6500 |