Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 110 W Main, Bryant, South Dakota |
Authorized Official Name and Position | John Mengenhausen (CEO) |
Authorized Official Contact | 6057725185 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 176 Bryant SD 57221-0176 Ph: (605) 628-2318 | 110 W Main Bryant SD 57221 Ph: (605) 628-2318 |
NPI Number | 1821102856 |
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Provider Enumeration Date | 08/18/2006 |
Last Update Date | 06/23/2008 |
Medicare PECOS PAC ID | 8921997933 |
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Medicare Enrollment ID | O20081113000506 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821102856 | NPI | - | NPPES |
5350040 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |