| Wall Clinic | |
|
112 7th Ave Wall SD 57790-0423 | |
| (605) 279-2149 | |
| (605) 279-2139 |
| Full Name | Wall Clinic |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 112 7th Ave, Wall, South Dakota |
| Authorized Official Name and Position | Ester Johannesen (CLINIC COORDINATOR) |
| Authorized Official Contact | 6052792149 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wall Clinic Po Box 423 Wall SD 57790-0423 Ph: (605) 279-2149 | Wall Clinic 112 7th Ave Wall SD 57790-0423 Ph: (605) 279-2149 |
| NPI Number | 1063494789 |
|---|---|
| Provider Enumeration Date | 11/17/2005 |
| Last Update Date | 03/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063494789 | NPI | - | NPPES |
| 5300040 | Medicaid | SD | |
| 4999946 | Other | SD | BCBS # FOR WALL CLINIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Wall Regional Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 7th Avenue, Wall, SD 57790 Phone: 605-279-2149 Fax: 605-279-2139 | |
Wall Regional Medical Clinic Part B Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 7th Avenue, Wall, SD 57790 Phone: 605-279-2149 Fax: 605-279-1027 | |
Wall Regional Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 112 7th Avenue, Wall, SD 57790 Phone: 605-279-2149 Fax: 605-279-1027 | |
Wall Regional Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 7th Avenue, Wall, SD 57790 Phone: 605-279-2149 Fax: 605-279-2139 | |
Wall Regional Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 7th Avenue, Wall, SD 57790 Phone: 605-279-2149 Fax: 605-279-2139 |