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302 S Dumont Woonsocket SD 57385-0368 | |
(605) 796-4433 | |
(605) 796-4338 |
Full Name | |
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Speciality | Clinic/Center |
Location | 302 S Dumont, Woonsocket, South Dakota |
Authorized Official Name and Position | John Mengenhausen (CEO) |
Authorized Official Contact | 6057724525 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 368 Woonsocket SD 57385-0368 Ph: (605) 796-4433 | 302 S Dumont Woonsocket SD 57385-0368 Ph: (605) 796-4433 |
NPI Number | 1033227053 |
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Provider Enumeration Date | 08/29/2006 |
Last Update Date | 01/18/2017 |
Medicare PECOS PAC ID | 8921997933 |
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Medicare Enrollment ID | O20080922000442 |
Identifier | Type | State | Issuer |
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1033227053 | NPI | - | NPPES |
5350122 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |