NPIMap

Organization Active NPI

Graham Ear, Nose & Throat P.C.

  • Facial Plastic Surgery Physician
  • Mitchell, SD
National Provider Identifier
1063647154
Registry record updated May 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X
License
4248 Issued in SD
Legal business name
GRAHAM EAR, NOSE & THROAT P.C.
Practice address
625 N Foster St Ste 203
Mitchell, SD 57301-2969
Phone
(605) 996-8386
Fax
(605) 996-9153
NPI assigned
May 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Noble Graham, D.O.
Title
Owner
Phone
(605) 996-8386

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Facial Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207YS0123X 4248 SD Primary

Addresses

Primary practice location

625 N Foster St Ste 203
Mitchell, SD 57301-2969

Mailing address

625 N Foster St Ste 203
Mitchell, SD 57301-2969
Phone (605) 996-8386

Other identifiers 4

IdentifierTypeStateIssuer
20223OtherSDSANFORD HEALTH
6520252MedicaidSD
2070OtherSDAVERA HEALTH
0005047OtherSDBLUE CROSS BLUE SHILED

National Provider Directory

National Provider Directory

Locations

625 N Foster St
Ste 203
Mitchell, SD 57301
Phone (605) 996-8386

601 E 7th St
Ste 1
Platte, SD 57369
Phone (605) 337-2633

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242691200000",
    "number": "1063647154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 N FOSTER ST STE 203",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012969",
            "telephone_number": "605-996-8386",
            "fax_number": "605-996-9153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 N FOSTER ST STE 203",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012969",
            "telephone_number": "605-996-8386",
            "fax_number": "605-996-9153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM EAR, NOSE & THROAT P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-19",
        "last_updated": "2009-05-19",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "NOBLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-996-8386",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "SD",
            "license": "4248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SANFORD HEALTH",
            "identifier": "20223",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6520252",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVERA HEALTH",
            "identifier": "2070",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHILED",
            "identifier": "0005047",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mitchell, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.