Healthcare Provider Details

I. General information

NPI: 1609453422
Provider Name (Legal Business Name): PHILIP CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W PINE ST
PHILIP SD
57567-3300
US

IV. Provider business mailing address

PO BOX 550
PHILIP SD
57567-0550
US

V. Phone/Fax

Practice location:
  • Phone: 605-859-2566
  • Fax: 605-859-2948
Mailing address:
  • Phone: 605-859-2566
  • Fax: 605-859-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5340090
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: CINDY FAY PFEIFLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 605-859-2511