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314 Mellette Street Bonesteel SD 57317-0342 | |
(605) 654-9021 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 314 Mellette Street, Bonesteel, South Dakota |
Authorized Official Name and Position | Mistie Drey (CEO) |
Authorized Official Contact | 6057752621 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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314 Mellette Street Bonesteel SD 57317-0342 Ph: (605) 654-9021 | 314 Mellette Street Bonesteel SD 57317-0342 Ph: (605) 654-9021 |
NPI Number | 1033147384 |
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Provider Enumeration Date | 06/28/2006 |
Last Update Date | 10/25/2022 |
Medicare PECOS PAC ID | 2163317900 |
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Medicare Enrollment ID | O20040519000690 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033147384 | NPI | - | NPPES |
5340240 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (South Dakota) | Primary |