| Destiny Healthcare International, Inc | |
|
1417 S Minnesota Ave Sioux Falls SD 57105-1715 | |
| (605) 339-3378 | |
| (605) 339-0710 |
| Full Name | Destiny Healthcare International, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1417 S Minnesota Ave, Sioux Falls, South Dakota |
| Authorized Official Name and Position | Brian K Kidman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6053393378 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Destiny Healthcare International, Inc 1417 S Minnesota Ave Sioux Falls SD 57105-1715 Ph: (605) 339-3378 | Destiny Healthcare International, Inc 1417 S Minnesota Ave Sioux Falls SD 57105-1715 Ph: (605) 339-3378 |
| NPI Number | 1356369995 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 03/17/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356369995 | NPI | - | NPPES |
| 6701870 | Medicaid | SD | |
| 5604647 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1799 (South Dakota) | Primary |
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