Healthcare Provider Details

I. General information

NPI: 1669616496
Provider Name (Legal Business Name): SACRED HEART RURAL HEALTH CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 SUMMIT ST SUITE 2800
YANKTON SD
57078-3734
US

IV. Provider business mailing address

1000 W 4TH ST SUITE 8
YANKTON SD
57078-3730
US

V. Phone/Fax

Practice location:
  • Phone: 605-665-6820
  • Fax: 605-665-6821
Mailing address:
  • Phone: 605-655-1201
  • Fax: 605-655-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAM REZAC
Title or Position: CEO/PRESIDENT
Credential:
Phone: 605-668-8000