| Jen Med Prof Llc | |
|
1010 Ballpark Rd Suite 2 Sturgis SD 57785-2364 | |
| (605) 347-3684 | |
| (605) 347-0083 |
| Full Name | Jen Med Prof Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1010 Ballpark Rd, Sturgis, South Dakota |
| Authorized Official Name and Position | George W. Jenter (OWNER/OPERATOR) |
| Authorized Official Contact | 6053473684 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jen Med Prof Llc 1010 Ballpark Rd Suite 2 Sturgis SD 57785-2364 Ph: (605) 347-3684 | Jen Med Prof Llc 1010 Ballpark Rd Suite 2 Sturgis SD 57785-2364 Ph: (605) 347-3684 |
| NPI Number | 1528020229 |
|---|---|
| Provider Enumeration Date | 04/06/2006 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528020229 | NPI | - | NPPES |
| 142389900 | Other | SD | OWCP PROVIDER |
| 42339 | Other | SD | RADIATION MEDICAL LICENSE |
| 14172-1 | Other | SD | FAA LICENSE NUMBER |
| 5602360 | Other | SD | TITLE 19 |
| S2312 | Other | SD | MEDICARE PTAN |
| 1034 | Other | SD | PHYSICIAN'S LICENSE |
| 43D0408177 | Other | SD | CLIA LAB |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1034 (South Dakota) | Primary |
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