Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 112 7th Avenue, Wall, South Dakota |
Authorized Official Name and Position | John Pierce (MONUMENT HEALTH PRESIDENT) |
Authorized Official Contact | 6057558162 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 860013 Minneapolis MN 55486-0013 Ph: (605) 279-2149 | 112 7th Avenue Wall SD 57790-0001 Ph: (605) 279-2149 |
NPI Number | 1457730673 |
---|---|
Provider Enumeration Date | 05/20/2015 |
Last Update Date | 03/16/2020 |
Medicare PECOS PAC ID | 6002729506 |
---|---|
Medicare Enrollment ID | O20160308000849 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457730673 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |