Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 303 S Main St, Onida, South Dakota |
Authorized Official Name and Position | James M Hardwick (CEO) |
Authorized Official Contact | 6052232200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
202 Island Dr Ste 1 Fort Pierre SD 57532-7303 Ph: (605) 258-2635 | 303 S Main St Onida SD 57564-2160 Ph: (605) 258-2635 |
NPI Number | 1992793616 |
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Provider Enumeration Date | 10/06/2005 |
Last Update Date | 04/24/2023 |
Medicare PECOS PAC ID | 3476447541 |
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Medicare Enrollment ID | O20091124000349 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992793616 | NPI | - | NPPES |
0000054 | Other | SD | BCBS GROUP PROVIDER NUMBE |
5350140 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |