| Family Medicine Clinic Of Yankton Professional Llc | |
|
1000 West 4th Street Suite 15 Family Medicine Clinic Of Yankton Prof Llc Yankton SD 57078 | |
| (605) 665-0555 | |
| (605) 665-4498 |
| Full Name | Family Medicine Clinic Of Yankton Professional Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 West 4th Street, Yankton, South Dakota |
| Authorized Official Name and Position | Kelly R Rafferty (SOLE MEMBER) |
| Authorized Official Contact | 6056650555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Clinic Of Yankton Professional Llc 1000 West 4th Street Suite 15 Family Medicine Clinic Of Yankton Prof Llc Yankton SD 57078 Ph: (605) 665-0555 | Family Medicine Clinic Of Yankton Professional Llc 1000 West 4th Street Suite 15 Family Medicine Clinic Of Yankton Prof Llc Yankton SD 57078 Ph: (605) 665-0555 |
| NPI Number | 1811088727 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 04/05/2013 |
| Medicare PECOS PAC ID | 3072425131 |
|---|---|
| Medicare Enrollment ID | O20031105000697 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811088727 | NPI | - | NPPES |
| 5610162 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4270 (South Dakota) | Primary |
| Provider Name | Kelly Rae Rafferty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609911098 PECOS PAC ID: 0941112015 Enrollment ID: I20031110000402 |
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