Provider Demographics
NPI:1578595062
Name:UNION COUNTY HEALTH FOUNDATION
Entity Type:Organization
Organization Name:UNION COUNTY HEALTH FOUNDATION
Other - Org Name:ALCESTER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
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:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:ALCESTER
Mailing Address - State:SD
Mailing Address - Zip Code:57001-0468
Mailing Address - Country:US
Mailing Address - Phone:605-934-2122
Mailing Address - Fax:
Practice Address - Street 1:104 W SECOND ST
Practice Address - Street 2:
Practice Address - City:ALCESTER
Practice Address - State:SD
Practice Address - Zip Code:57001
Practice Address - Country:US
Practice Address - Phone:605-934-2122
Practice Address - Fax:
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:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350070Medicaid
SD5350070Medicaid
SDS77908Medicare PIN