Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 409 4th St, Wilmot, South Dakota |
Authorized Official Name and Position | Craig Kantos (ADMINISTRATOR, CEO) |
Authorized Official Contact | 6056987647 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
205 Orchard Dr Sisseton SD 57262-2312 Ph: (605) 698-7681 | 409 4th St Wilmot SD 57279-2214 Ph: (605) 938-4351 |
NPI Number | 1710033220 |
---|---|
Provider Enumeration Date | 01/26/2007 |
Last Update Date | 08/14/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710033220 | NPI | - | NPPES |
5340230 | Medicaid | SD | |
12440 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |