David Van Dyke MD SC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

19557020 Issued in WI

Legal business name

DAVID VAN DYKE MD SC

Practice address

122 W South St
Viroqua, WI 54665-0187

Phone

(608) 637-2511

Fax

(608) 637-7921

NPI assigned

Feb 1, 2007

Organization subpart

No

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

Authorized official

Name

Julie C Noth

Title

Clinic Director

Phone

(608) 637-2511

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295873529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 187",
            "address_2": "122 W SOUTH ST",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "546650187",
            "telephone_number": "608-637-2511",
            "fax_number": "608-637-7921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 W SOUTH ST",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "546650187",
            "telephone_number": "608-637-2511",
            "fax_number": "608-637-7921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID VAN DYKE MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NOTH",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "608-637-2511"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "19557020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30101600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexa Ann Colburn, NP
• Michael Corr, D.C.
• County of Vernon
• County of Vernon
• Amy Jean Crofts, RN, CNM, MSN
• Bonnie L Davidson, MD
• Miranda Dayton
• Dean Saner, Psy.D., LLC
• Sondra Delap
• Paul A Deutsch, LPC

• All providers in Viroqua, WI
• Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.