1922416320 NPI number — MONUMENT HEALTH NETWORK, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922416320 NPI number — MONUMENT HEALTH NETWORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONUMENT HEALTH NETWORK, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1922416320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 860013
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55486-0013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-755-7649
Provider Business Mailing Address Fax Number:
605-755-7884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 MONTGOMERY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUSTER
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57730-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-673-2229
Provider Business Practice Location Address Fax Number:
605-673-3586
Provider Enumeration Date:
07/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WORSLEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT HILLS MARKET
Authorized Official Telephone Number:
605-644-4091

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 47660 . This is a "HOSPITAL LICENSE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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