Healthcare Provider Details

I. General information

NPI: 1063494789
Provider Name (Legal Business Name): WALL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 7TH AVE
WALL SD
57790-0423
US

IV. Provider business mailing address

PO BOX 423
WALL SD
57790-0423
US

V. Phone/Fax

Practice location:
  • Phone: 605-279-2149
  • Fax: 605-279-2139
Mailing address:
  • Phone: 605-279-2149
  • Fax: 605-279-2139

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: MRS. ESTER JOHANNESEN
Title or Position: CLINIC COORDINATOR
Credential:
Phone: 605-279-2149