Provider Demographics
NPI:1548351620
Name:BERNARD J LINN
Entity type:Organization
Organization Name:BERNARD J LINN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-945-1371
Mailing Address - Street 1:1601 N HARRISON AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2376
Mailing Address - Country:US
Mailing Address - Phone:605-945-1371
Mailing Address - Fax:605-945-3237
Practice Address - Street 1:1601 N HARRISON AVE STE 6
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2383
Practice Address - Country:US
Practice Address - Phone:605-945-1371
Practice Address - Fax:605-945-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11694Medicaid
ND11694Medicaid