MEDICARE: UNION COUNTY HEALTH FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326070814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION COUNTY HEALTH FOUNDATION

Provider Business Mailing Address
First Line	:	204 EAST MAIN STREET
Second Line	:	BOX 798
City	:	ELK POINT
State	:	SD
Zip	:	57025
Country	:	US
Telephone Number	:	605-356-3317
Fax Number	:	605-356-2721

Provider Business Practice Location Address
First Line	:	204 E MAIN ST
Second Line	:
City	:	ELK POINT
State	:	SD
Zip	:	57025-2334
Country	:	US
Telephone Number	:	605-356-3317
Fax Number	:	605-356-2721

Authorized Official
Title or Position	:	COO
Name	:	MR. BRAD BERTRAND
Credential	:
Telephone Number	:	605-356-3317

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/03/2011

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Directions to “UNION COUNTY HEALTH FOUNDATION ” Practice Location

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