=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619344405
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONUMENT HEALTH NETWORK, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2015
-----------------------------------------------------
Last Update Date | 02/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2140 JUNCTION AVE
-----------------------------------------------------
City | STURGIS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-720-2600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 860013
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55486-0013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-720-2600
-----------------------------------------------------
Fax | 605-755-7884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT SPEARFISH HOSPITAL HILLS
-----------------------------------------------------
Name | THOMAS S WORSLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-644-4091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------