Healthcare Provider Details

I. General information

NPI: 1790863405
Provider Name (Legal Business Name): HENDRICKS COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 EAST FIFTH STREET
WHITE SD
57276
US

IV. Provider business mailing address

PO BOX 106
HENDRICKS MN
56136-0106
US

V. Phone/Fax

Practice location:
  • Phone: 605-629-8211
  • Fax: 605-629-8291
Mailing address:
  • Phone: 507-275-3134
  • Fax: 507-275-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number11137
License Number StateSD

VIII. Authorized Official

Name: JEFF GOLLAHER
Title or Position: CEO
Credential:
Phone: 507-275-3134