Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 247100000X | Radiologic Technologist | | 42168 | SOUTH DAKOTA | No |
2 | 2471B0102X | Radiologic Technologist | Bone Densitometry | 42168 | SOUTH DAKOTA | No |
3 | 246XS1301X | Specialist/Technologist Cardiovascular | Sonography | 48461 | SOUTH DAKOTA | No |
4 | 246XC2903X | Specialist/Technologist Cardiovascular | Vascular Specialist | 48461 | SOUTH DAKOTA | No |
5 | 374700000X | Technician | | 18136 | SOUTH DAKOTA | No |
6 | 2471N0900X | Radiologic Technologist | Nuclear Medicine Technology | 42168 | SOUTH DAKOTA | No |
7 | 291U00000X | Clinical Medical Laboratory | | 43D0407438 | SOUTH DAKOTA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
1 | 690006160 | OTHER | SOUTH DAKOTA | RAILROAD MEDICARE |
2 | 2417 | MEDICARE PIN | SOUTH DAKOTA | |