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105 W Main St. Bison SD 57620-0427 | |
(605) 244-5206 | |
(605) 244-5208 |
Full Name | |
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Speciality | Clinic/Center |
Location | 105 W Main St., Bison, South Dakota |
Authorized Official Name and Position | John Mengenhausen (AUTHORIZED OFFICIAL CEO) |
Authorized Official Contact | 6057724525 |
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 427 Bison SD 57620-0427 Ph: (605) 244-5206 | 105 W Main St. Bison SD 57620-0427 Ph: (605) 244-5206 |
NPI Number | 1598731648 |
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Provider Enumeration Date | 02/28/2006 |
Last Update Date | 02/09/2017 |
Medicare PECOS PAC ID | 8921997933 |
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Medicare Enrollment ID | O20160209002559 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598731648 | NPI | - | NPPES |
5350300 | Medicaid | SD | |
42509 | Other | MED B GROUP |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |