Provider Demographics
NPI:1508813957
Name:SACRED HEART RURAL HEALTH CLINICS
Entity Type:Organization
Organization Name:SACRED HEART RURAL HEALTH CLINICS
Other - Org Name:AVERA MEDICAL GROUP HARTINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
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 1:405 W DARLENE ST
Practice Address - Street 2:
Practice Address - City:HARTINGTON
Practice Address - State:NE
Practice Address - Zip Code:68739-4806
Practice Address - Country:US
Practice Address - Phone:402-254-3935
Practice Address - Fax:402-254-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========23Medicaid
NE=========23Medicaid
NE099209Medicare ID - Type UnspecifiedNON-RURAL HEALTH #