| |
1039 Montgomery St, Custer, SD 57730-1304 | |
(605) 673-2229 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Dietitian, Registered |
Location | 1039 Montgomery St, Custer, South Dakota |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1245479146 | NPI | - | NPPES |
5590310 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 47660 (South Dakota) | Primary |
Mailing Address | Practice Location Address |
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Po Box 3450, Rapid City, SD 57709-3450 Ph: (605) 673-2229 | 1039 Montgomery St, Custer, SD 57730-1304 Ph: (605) 673-2229 |