Healthcare Provider Details

I. General information

NPI: 1457191942
Provider Name (Legal Business Name): GOLDEN HEART MEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 SUMMIT ST
BELLE FOURCHE SD
57717-2069
US

IV. Provider business mailing address

319 SUMMIT ST
BELLE FOURCHE SD
57717-2069
US

V. Phone/Fax

Practice location:
  • Phone: 605-723-4663
  • Fax: 605-723-4667
Mailing address:
  • Phone: 605-723-4663
  • Fax: 605-723-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESIKA L FLOYD
Title or Position: PRESIDENT
Credential: LPN
Phone: 605-723-4663