Healthcare Provider Details

I. General information

NPI: 1801273537
Provider Name (Legal Business Name): MONUMENT HEALTH NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
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: 605-673-9400
  • Fax: 605-755-0694
Mailing address:
  • Phone: 605-755-7649
  • Fax: 605-755-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK C SCHMIDT
Title or Position: PRESIDENT CUSTER LDWD MARKET
Credential:
Phone: 605-755-8094