Provider Demographics
NPI:1861602500
Name:CLIFFORD MATUSHIN PC
Entity type:Organization
Organization Name:CLIFFORD MATUSHIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MATUSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:605-229-2544
Mailing Address - Street 1:201 S LLOYD ST STE 140
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4519
Mailing Address - Country:US
Mailing Address - Phone:605-229-2544
Mailing Address - Fax:605-229-2115
Practice Address - Street 1:201 S LLOYD ST STE 140
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4519
Practice Address - Country:US
Practice Address - Phone:605-229-2544
Practice Address - Fax:605-229-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6002770Medicaid
SD4997166OtherBLUE CROSS
SD6002770Medicaid
SDS101635Medicare PIN