Healthcare Provider Details

I. General information

NPI: 1578595062
Provider Name (Legal Business Name): UNION COUNTY HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W SECOND ST
ALCESTER SD
57001
US

IV. Provider business mailing address

PO BOX 468
ALCESTER SD
57001-0468
US

V. Phone/Fax

Practice location:
  • Phone: 605-934-2122
  • Fax:
Mailing address:
  • Phone: 605-934-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BRAD BERTRAND
Title or Position: COO
Credential:
Phone: 605-356-3317