=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336196617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SACRED HEART RURAL HEALTH CLINICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 02/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 W MAIN ST
-----------------------------------------------------
City | CROFTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68730-3307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-388-2343
-----------------------------------------------------
Fax | 402-388-2554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 W 4TH ST STE 8
-----------------------------------------------------
City | YANKTON
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57078-3700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-655-1201
-----------------------------------------------------
Fax | 605-655-1210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | PAMELA J REZAC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-668-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------