Provider Demographics
NPI:1316182579
Name:SACRED HEART HEALTH SERVICES
Entity Type:Organization
Organization Name:SACRED HEART HEALTH SERVICES
Other - Org Name:AVERA REHAB PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-668-8000
Mailing Address - Street 1:1000 W 4TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3700
Mailing Address - Country:US
Mailing Address - Phone:605-655-1201
Mailing Address - Fax:605-655-1210
Practice Address - Street 1:1000 W 4TH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3730
Practice Address - Country:US
Practice Address - Phone:605-655-1201
Practice Address - Fax:605-655-1210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-02
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS31012Medicare PIN