Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 104 W Second St, Alcester, South Dakota |
Authorized Official Name and Position | Brad Bertrand (COO) |
Authorized Official Contact | 6053563317 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 468 Alcester SD 57001-0468 Ph: (605) 934-2122 | 104 W Second St Alcester SD 57001 Ph: (605) 934-2122 |
NPI Number | 1578595062 |
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Provider Enumeration Date | 07/07/2006 |
Last Update Date | 03/03/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578595062 | NPI | - | NPPES |
5350070 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |