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General NPI Number Information
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NPI Number | 1457191942
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Entity Type | Organization
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Legal Business Name | GOLDEN HEART MEDICAL CARE PLLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 319 SUMMIT ST
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City | BELLE FOURCHE
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State | SD
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Zip | 57717-2069
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Country | US
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Telephone | 605-723-4663
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Fax | 605-723-4667
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Provider Business Mailing Address
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Address Line | 319 SUMMIT ST
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City | BELLE FOURCHE
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State | SD
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Zip | 57717-2069
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Country | US
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Telephone | 605-723-4663
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Fax | 605-723-4667
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESIKA L FLOYD
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Credential | LPN
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Telephone | 605-723-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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