Provider Demographics
NPI:1508980913
Name:ST BENEDICT HEALTH CENTER
Entity Type:Organization
Organization Name:ST BENEDICT HEALTH CENTER
Other - Org Name:AVERA ST BENEDICT HEALTH CENTER COMMUNITY HEALTH
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 1:401 W GLYNN DR
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-9605
Mailing Address - Country:US
Mailing Address - Phone:605-928-3311
Mailing Address - Fax:605-928-7368
Practice Address - Street 1:401 W GLYNN DR
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366-9605
Practice Address - Country:US
Practice Address - Phone:605-928-3311
Practice Address - Fax:605-928-7368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5102120Medicaid
SD5102120Medicaid