Full Name | |
---|---|
Speciality | Clinic/center |
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) 698-7647 | 409 4th St Wilmot SD 57279-2214 Ph: (605) 938-4351 |
NPI Number | 1700925153 |
---|---|
Provider Enumeration Date | 02/05/2007 |
Last Update Date | 08/14/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700925153 | NPI | - | NPPES |
05160 | Medicaid | ND | |
3070116201 | Other | PRIMEWEST | |
0030064 | Other | BLUE CROSS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |