Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 517 Ave B, Pollick, South Dakota |
Authorized Official Name and Position | Robert Black (CEO) |
Authorized Official Contact | 7012544511 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
517 Ave B Pollick SD 57648 Ph: (605) 889-2376 | 517 Ave B Pollick SD 57648 Ph: (605) 889-2376 |
NPI Number | 1912916438 |
---|---|
Provider Enumeration Date | 08/05/2006 |
Last Update Date | 04/25/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912916438 | NPI | - | NPPES |
5300382 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |