Healthcare Provider Details

I. General information

NPI: 1003886250
Provider Name (Legal Business Name): HOVEN MEDICAL CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 5TH STREET
HOVEN SD
57450-0787
US

IV. Provider business mailing address

PO BOX 787
HOVEN SD
57450-0787
US

V. Phone/Fax

Practice location:
  • Phone: 605-948-2201
  • Fax:
Mailing address:
  • Phone: 605-948-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELLY JENSEN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-948-2262