| Faith Community Health Center | |
|
112 N 2nd Ave W Faith SD 57626-0577 | |
| (605) 967-2644 | |
| (605) 967-2844 |
| Full Name | Faith Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 112 N 2nd Ave W, Faith, South Dakota |
| Authorized Official Name and Position | John Mengenhausen (AUTHORIZED OFFICIAL CEO) |
| Authorized Official Contact | 6057724525 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Faith Community Health Center Po Box 577 Faith SD 57626-0577 Ph: (605) 967-2644 | Faith Community Health Center 112 N 2nd Ave W Faith SD 57626-0577 Ph: (605) 967-2644 |
| NPI Number | 1912972712 |
|---|---|
| Provider Enumeration Date | 02/23/2006 |
| Last Update Date | 02/06/2017 |
| Medicare PECOS PAC ID | 8921997933 |
|---|---|
| Medicare Enrollment ID | O20160209000730 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912972712 | NPI | - | NPPES |
| 40374 | Other | PART B GROUP # | |
| 5350130 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Cheyenne River Sioux Tribe Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 18190 1st Ave, Faith, SD 57626 Phone: 605-964-0772 |