Provider Demographics
NPI:1073992004
Name:MONUMENT HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:MONUMENT HEALTH NETWORK, INC.
Other - Org Name:BUFFALO REGIONAL MEDICAL CLINIC PART B
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT SPEARFISH HOSPITAL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WORSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-644-4091
Mailing Address - Street 1:PO BOX 860013
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0013
Mailing Address - Country:US
Mailing Address - Phone:605-375-3744
Mailing Address - Fax:605-755-7884
Practice Address - Street 1:209 RAMSLAND ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:SD
Practice Address - Zip Code:57720-0045
Practice Address - Country:US
Practice Address - Phone:605-375-3744
Practice Address - Fax:605-375-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty