Healthcare Provider Details

I. General information

NPI: 1255377412
Provider Name (Legal Business Name): MONUMENT HEALTH NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CHARLES ST
DEADWOOD SD
57732-1303
US

IV. Provider business mailing address

PO BOX 860013
MINNEAPOLIS MN
55486-0013
US

V. Phone/Fax

Practice location:
  • Phone: 605-722-6101
  • Fax:
Mailing address:
  • Phone: 605-717-6000
  • Fax: 605-717-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number10535
License Number StateSD

VIII. Authorized Official

Name: MARK C SCHMIDT
Title or Position: PRESIDENT CUSTER LD-DWD HOSPITAL
Credential:
Phone: 605-717-6020