Healthcare Provider Details

I. General information

NPI: 1659747012
Provider Name (Legal Business Name): MCLAUGHLIN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E. 6TH ST.
MCLAUGHLIN SD
57642
US

IV. Provider business mailing address

701 E. 6TH ST.
MC LAUGHLIN SD
57642-0879
US

V. Phone/Fax

Practice location:
  • Phone: 701-823-4458
  • Fax: 701-823-4470
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number6340
License Number StateSD

VIII. Authorized Official

Name: NICK THOMAS
Title or Position: CHIEF PHARMACIST
Credential:
Phone: 701-854-8340