Healthcare Provider Details

I. General information

NPI: 1770958837
Provider Name (Legal Business Name): BENNETT COUNTY RURAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MAJOR ALLEN ST
MARTIN SD
57551-6005
US

IV. Provider business mailing address

PO BOX 40
MARTIN SD
57551-0040
US

V. Phone/Fax

Practice location:
  • Phone: 605-685-1660
  • Fax: 605-685-1166
Mailing address:
  • Phone: 605-685-1660
  • Fax: 605-685-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number10549
License Number StateSD

VIII. Authorized Official

Name: MICHAEL CHRISTENSEN
Title or Position: CEO
Credential:
Phone: 605-685-6622