Full Name | |
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Speciality | Family Medicine |
Location | 112 7th Avenue, Wall, South Dakota |
Authorized Official Name and Position | Michael E Gibbs (PRESIDENT-RCRH) |
Authorized Official Contact | 6057558162 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 860013 Minneapolis MN 55486-0013 Ph: (605) 279-2149 | 112 7th Avenue Wall SD 57790-0000 Ph: (605) 279-2149 |
NPI Number | 1629457841 |
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Provider Enumeration Date | 05/20/2015 |
Last Update Date | 05/20/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629457841 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |