| |
116 Main Street Presho SD 57325-0027 | |
(605) 234-6584 | |
(605) 234-5002 |
Full Name | |
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Speciality | Clinic/Center |
Location | 116 Main Street, Presho, South Dakota |
Authorized Official Name and Position | James 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 |
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202 Island Dr Ste 1 Fort Pierre SD 57532-7303 Ph: (605) 853-2786 | 116 Main Street Presho SD 57325-0027 Ph: (605) 234-6584 |
NPI Number | 1528071297 |
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Provider Enumeration Date | 08/14/2006 |
Last Update Date | 04/24/2023 |
Medicare PECOS PAC ID | 3476447541 |
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Medicare Enrollment ID | O20081114000111 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528071297 | NPI | - | NPPES |
1002102 | Other | SD | WELLMARK BCBS |
5350290 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |