Provider Demographics
NPI:1114931797
Name:ST. BENEDICT HEALTH CENTER
Entity Type:Organization
Organization Name:ST. BENEDICT HEALTH CENTER
Other - Org Name:AVERA ST. BENEDICT CERTIFIED RURAL HEALTH CLINIC, LAKE ANDES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-928-3311
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:LAKE ANDES
Mailing Address - State:SD
Mailing Address - Zip Code:57356-0279
Mailing Address - Country:US
Mailing Address - Phone:605-487-7878
Mailing Address - Fax:605-487-9566
Practice Address - Street 1:756 EAST LAKE STREET
Practice Address - Street 2:
Practice Address - City:LAKE ANDES
Practice Address - State:SD
Practice Address - Zip Code:57356
Practice Address - Country:US
Practice Address - Phone:605-487-7878
Practice Address - Fax:605-487-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5340060Medicaid
SDS7362Medicare PIN
SDCH2949Medicare PIN
SD5340060Medicaid