Provider Demographics
NPI:1518914829
Name:MELLETTE COUNTY HEALTH CLINIC
Entity Type:Organization
Organization Name:MELLETTE COUNTY HEALTH CLINIC
Other - Org Name:HORIZON HEALTH CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:605-259-3121
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER
Mailing Address - State:SD
Mailing Address - Zip Code:57579-0281
Mailing Address - Country:US
Mailing Address - Phone:605-259-3121
Mailing Address - Fax:605-259-3444
Practice Address - Street 1:FIRST AND ROOSEVELT
Practice Address - Street 2:
Practice Address - City:WHITE RIVER
Practice Address - State:SD
Practice Address - Zip Code:57579-0281
Practice Address - Country:US
Practice Address - Phone:605-259-3121
Practice Address - Fax:605-259-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0004261Q00000X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350230Medicaid
SD40404Medicare PIN
SDS00343Medicare UPIN
SD431824Medicare Oscar/Certification