Healthcare Provider Details

I. General information

NPI: 1922416320
Provider Name (Legal Business Name): MONUMENT HEALTH NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 10/09/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MONTGOMERY ST
CUSTER SD
57730-1705
US

IV. Provider business mailing address

PO BOX 860013
MINNEAPOLIS MN
55486-0013
US

V. Phone/Fax

Practice location:
  • Phone: 605-673-2229
  • Fax: 605-673-3586
Mailing address:
  • Phone: 605-755-7649
  • Fax: 605-755-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS WORSLEY
Title or Position: PRESIDENT HILLS MARKET
Credential:
Phone: 605-644-4091