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208 W Main Street Mcintosh SD 57641-0195 | |
(605) 273-4335 | |
(605) 273-4360 |
Full Name | |
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Speciality | Clinic/Center |
Location | 208 W Main Street, Mcintosh, 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 |
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Po Box 195 Mc Intosh SD 57641-0195 Ph: (605) 273-4335 | 208 W Main Street Mcintosh SD 57641-0195 Ph: (605) 273-4335 |
NPI Number | 1609842665 |
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Provider Enumeration Date | 02/28/2006 |
Last Update Date | 02/06/2017 |
Medicare PECOS PAC ID | 8921997933 |
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Medicare Enrollment ID | O20160209001840 |
Identifier | Type | State | Issuer |
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1609842665 | NPI | - | NPPES |
5350260 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |