Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 112 7th Avenue, Wall, South Dakota |
Authorized Official Name and Position | John Y Pierce (CEO) |
Authorized Official Contact | 6057559042 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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353 Fairmont Blvd Rapid City SD 57701-7375 Ph: (605) 755-9142 | 112 7th Avenue Wall SD 57790 Ph: (605) 279-2149 |
NPI Number | 1003230541 |
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Provider Enumeration Date | 02/04/2014 |
Last Update Date | 02/06/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003230541 | NPI | - | NPPES |
S300040 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |