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211 N Commercial St Ste B Clark SD 57225-1525 | |
(605) 532-3676 | |
(605) 532-5620 |
Full Name | |
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Speciality | Clinic/Center |
Location | 211 N Commercial St Ste B, Clark, South Dakota |
Authorized Official Name and Position | Tony Lee Morrison (VP, REVENUE CYCLE) |
Authorized Official Contact | 6053288380 |
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 5074 Sioux Falls SD 57117-5074 Ph: (605) 328-6585 | 211 N Commercial St Ste B Clark SD 57225-1525 Ph: (605) 532-3676 |
NPI Number | 1699755413 |
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Provider Enumeration Date | 01/18/2006 |
Last Update Date | 12/19/2022 |
Medicare PECOS PAC ID | 8325950215 |
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Medicare Enrollment ID | O20230114000037 |
Identifier | Type | State | Issuer |
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1699755413 | NPI | - | NPPES |
5306712 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |