Healthcare Provider Details

I. General information

NPI: 1598195208
Provider Name (Legal Business Name): PRAIRIE HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 8TH ST
ARMOUR SD
57313-2102
US

IV. Provider business mailing address

708 8TH ST
ARMOUR SD
57313-2102
US

V. Phone/Fax

Practice location:
  • Phone: 605-724-2151
  • Fax: 605-724-2310
Mailing address:
  • Phone: 605-724-2151
  • Fax: 605-724-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE J NEUGEBAUER
Title or Position: BILLING
Credential:
Phone: 605-724-2151