| Centerville Medical Clinic | |
|
512 Broadway Centerville SD 57014-0070 | |
| (605) 563-2411 | |
| (605) 563-2060 |
| Full Name | Centerville Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 512 Broadway, Centerville, South Dakota |
| Authorized Official Name and Position | Georgia Pokorney (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6053265161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerville Medical Clinic Po Box 368 Viborg SD 57070-0368 Ph: (605) 326-5161 | Centerville Medical Clinic 512 Broadway Centerville SD 57014-0070 Ph: (605) 563-2411 |
| NPI Number | 1528017662 |
|---|---|
| Provider Enumeration Date | 05/08/2006 |
| Last Update Date | 01/04/2012 |
| Medicare PECOS PAC ID | 9234042755 |
|---|---|
| Medicare Enrollment ID | O20100716000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528017662 | NPI | - | NPPES |
| 4993935 | Other | SD | BLUE CROSS BLUE SHIELD |
| 5340280 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (South Dakota) | Primary |
Pioneer Memorial Hospital & Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 512 Broadway St, Centerville, SD 57014 Phone: 605-563-2411 Fax: 605-563-2060 |