Provider Demographics
NPI:1326070814
Name:UNION COUNTY HEALTH FOUNDATION
Entity Type:Organization
Organization Name:UNION COUNTY HEALTH FOUNDATION
Other - Org Name:COMMUNITY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-356-3317
Mailing Address - Street 1:204 EAST MAIN STREET
Mailing Address - Street 2:BOX 798
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025
Mailing Address - Country:US
Mailing Address - Phone:605-356-3317
Mailing Address - Fax:605-356-2721
Practice Address - Street 1:204 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK POINT
Practice Address - State:SD
Practice Address - Zip Code:57025-2334
Practice Address - Country:US
Practice Address - Phone:605-356-3317
Practice Address - Fax:605-356-2721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION COUNTY HEALTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350080Medicaid
SD5350080Medicaid
SD431805Medicare Oscar/Certification