Provider Demographics
NPI:1548434889
Name:SCSA DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:SCSA DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:EVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, HCLD
Authorized Official - Phone:605-692-5938
Mailing Address - Street 1:807 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-4716
Mailing Address - Country:US
Mailing Address - Phone:605-692-5938
Mailing Address - Fax:605-692-9730
Practice Address - Street 1:807 32ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-4716
Practice Address - Country:US
Practice Address - Phone:605-692-5938
Practice Address - Fax:605-692-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4992615OtherNON-PROVIDING