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701 3rd Ave S Clear Lake SD 57226-2016 | |
(605) 874-2141 | |
(605) 874-3525 |
Full Name | |
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Speciality | Community/Behavioral Health |
Location | 701 3rd Ave S, Clear Lake, South Dakota |
Authorized Official Name and Position | Tony Lee Morrison (VICE PRESIDENT, REVENUE CYCLE) |
Authorized Official Contact | 6053288380 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 5074 Sioux Falls SD 57117-5074 Ph: (605) 328-6585 | 701 3rd Ave S Clear Lake SD 57226-2016 Ph: (605) 874-2141 |
NPI Number | 1649472093 |
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Provider Enumeration Date | 06/05/2007 |
Last Update Date | 07/02/2020 |
Certification Date | 07/02/2020 |
Medicare PECOS PAC ID | 6800707100 |
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Medicare Enrollment ID | O20080121000133 |
Identifier | Type | State | Issuer |
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1649472093 | NPI | - | NPPES |
5102162 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |