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Please note that an application fee only extends an initial license to the next renewal date. Initial licenses do vary in duration. It is the responsibility of all licensees to renew their license before expiration. Failure to renew shall result in automatic forfeiture or suspension of the license by statute. Licenses which have forfeited are not automatically entitled to renew.

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Medical Corporation / PA Corporation Renewal Application

The Medical Corporation Certificate of Registration is valid until January 1, 2017. To renew this certificate the renewal application must be successfully completed and submitted prior to this date. If you have any questions please contact us by emailing sdbmoe@state.sd.us.

Indicate the full legal name of your corporation. (If the name has changed in the last year you must provide a copy of the legal document supporting the corporate name change.)
If the name has changed in the last year you must provide a copy of the legal document supporting the corporate name change.
Name of Contact Person
Primary specialty or emphasis of practice
Complete physical and mailing address for the Corporation
Email Address for the corporation if different from the Contact Person email address.
Upload a file with the complete list of the shareholders/members for the corporation. This list should also indicate the officers of the corporation: Example of the information to be included in the file: John Doe, MD - President 101 N Main, Suite 301 Sioux Falls, SD 57104
Electronic Signature and date of person completing the renewal application.
MM/YY
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