1801989967 NPI number — SACRED HEART RURAL HEALTH CLINICS

Table of content: (NPI 1801989967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801989967 NPI number — SACRED HEART RURAL HEALTH CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED HEART RURAL HEALTH CLINICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AVERA MEDICAL GROUP NIOBRARA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801989967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 W 4TH ST
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
YANKTON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57078-3730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-655-1201
Provider Business Mailing Address Fax Number:
605-655-1210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25410 PARK AVE
Provider Second Line Business Practice Location Address:
APARTMENT E
Provider Business Practice Location Address City Name:
NIOBRARA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68760-7044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-857-3398
Provider Business Practice Location Address Fax Number:
402-857-3315
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REZAC
Authorized Official First Name:
PAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
605-668-8322

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 921087 . This is a "DAKOTACARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025008100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com