Avera St. Benedict Certified Rural Health Clinic, Parkston | |
401 W Glynn Dr Parkston SD 57366-9605 | |
(605) 928-7961 | |
(605) 928-4417 |
Full Name | Avera St. Benedict Certified Rural Health Clinic, Parkston |
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Speciality | Clinic/Center |
Location | 401 W Glynn Dr, Parkston, South Dakota |
Authorized Official Name and Position | Lindsay R Weber (CEO) |
Authorized Official Contact | 6059283311 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Avera St. Benedict Certified Rural Health Clinic, Parkston 401 W Glynn Dr Parkston SD 57366-9605 Ph: (605) 928-7961 | Avera St. Benedict Certified Rural Health Clinic, Parkston 401 W Glynn Dr Parkston SD 57366-9605 Ph: (605) 928-7961 |
NPI Number | 1295758266 |
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Provider Enumeration Date | 07/25/2006 |
Last Update Date | 11/30/2022 |
Medicare PECOS PAC ID | 4880507672 |
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Medicare Enrollment ID | O20040129001118 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295758266 | NPI | - | NPPES |
0007353 | Other | SD | WELLMARK PARKSTON CLINIC |
5340070 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Jason W Wickersham |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1073594172 PECOS PAC ID: 7810889763 Enrollment ID: I20040504000306 |
Provider Name | Darin Ray Brink |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1376655050 PECOS PAC ID: 6608841978 Enrollment ID: I20040831000139 |
Provider Name | Rebecca J Moke |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083809206 PECOS PAC ID: 0941397582 Enrollment ID: I20071030000322 |
Provider Name | David C Arend |
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Provider Type | Practitioner - Urology |
Provider Identifiers | NPI Number: 1548478118 PECOS PAC ID: 0941375505 Enrollment ID: I20080815000278 |
Provider Name | Richard W Honke |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1104807858 PECOS PAC ID: 1951431196 Enrollment ID: I20100706000206 |
Provider Name | Antoinette J Vanderpol |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1689655789 PECOS PAC ID: 7214910694 Enrollment ID: I20100709000365 |
Provider Name | Kynan C Trail |
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Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1962452458 PECOS PAC ID: 6305749912 Enrollment ID: I20111103000495 |
Provider Name | Lindsay Rae Weber |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770867715 PECOS PAC ID: 5698949618 Enrollment ID: I20111130000762 |
Provider Name | Vicki R Lubbers |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1629461520 PECOS PAC ID: 7416277413 Enrollment ID: I20150514001333 |
Provider Name | Larissa Sanger |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1518287457 PECOS PAC ID: 1951543404 Enrollment ID: I20151105001496 |
Provider Name | Jedd D Bialas |
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Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1003157488 PECOS PAC ID: 8123266897 Enrollment ID: I20160226000897 |
Provider Name | Annie Thury |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639617731 PECOS PAC ID: 7113204017 Enrollment ID: I20170502001362 |
Provider Name | Cody G Freudenthal |
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Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1972965903 PECOS PAC ID: 0345549036 Enrollment ID: I20190219001887 |
Provider Name | Jessica Freudenthal |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114485364 PECOS PAC ID: 1153662853 Enrollment ID: I20190405002160 |
Provider Name | Paul D Berndt |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1962936856 PECOS PAC ID: 0749604577 Enrollment ID: I20200727000611 |
Provider Name | Melody A Shrack |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1306131602 PECOS PAC ID: 1658523865 Enrollment ID: I20201106001077 |
Provider Name | Molly C Mcmanus |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285117028 PECOS PAC ID: 4486994688 Enrollment ID: I20210902002980 |
Provider Name | Ashleigh E Eilts |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164095113 PECOS PAC ID: 6608274386 Enrollment ID: I20211011001489 |
Provider Name | Mariah L Suess |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518692524 PECOS PAC ID: 8820473101 Enrollment ID: I20220922002810 |
Provider Name | Elizabeth E Paul |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1568197580 PECOS PAC ID: 6901279777 Enrollment ID: I20230224002047 |
Provider Name | Janice L Gerlach |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1649833401 PECOS PAC ID: 1759617335 Enrollment ID: I20231205003911 |
Provider Name | Kerri L Lutjens |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023716792 PECOS PAC ID: 7911357785 Enrollment ID: I20231220002850 |
Provider Name | Hali M Hutcheson |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1669832945 PECOS PAC ID: 1254782378 Enrollment ID: I20240112001431 |
Avera St Benedict Crhc Parkston Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 W Glynn Dr, Parkston, SD 57366 Phone: 605-928-7961 Fax: 605-928-4417 |