| Sc Clinical Llc | |
|
213 E Hustan Ave Fort Pierre SD 57532-5103 | |
| (605) 609-7873 | |
| (605) 223-9201 |
| Full Name | Sc Clinical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 213 E Hustan Ave, Fort Pierre, South Dakota |
| Authorized Official Name and Position | Shane Clarambeau (OWNER/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6052227559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sc Clinical Llc 213 E Hustan Ave Fort Pierre SD 57532-5103 Ph: (605) 609-7873 | Sc Clinical Llc 213 E Hustan Ave Fort Pierre SD 57532-5103 Ph: (605) 609-7873 |
| NPI Number | 1720732589 |
|---|---|
| Provider Enumeration Date | 02/09/2022 |
| Last Update Date | 02/09/2022 |
| Medicare PECOS PAC ID | 1850788035 |
|---|---|
| Medicare Enrollment ID | O20220419001384 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720732589 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Pavel Conovalciuc |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720017080 PECOS PAC ID: 4587673504 Enrollment ID: I20220422001932 |
Access Health - Fort Pierre Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 202 Island Dr Ste 1, Fort Pierre, SD 57532 Phone: 605-223-2200 Fax: 605-223-2228 |