Provider Demographics
NPI:1598144719
Name:MONUMENT HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:MONUMENT HEALTH NETWORK, INC.
Other - Org Name:MONUMENT HEALTH BELLE FOURCHE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT SPEARFISH HOSPITAL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WORSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-644-4091
Mailing Address - Street 1:PO BOX 860013
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0013
Mailing Address - Country:US
Mailing Address - Phone:605-723-8970
Mailing Address - Fax:605-723-8971
Practice Address - Street 1:2200 13TH AVE
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-2215
Practice Address - Country:US
Practice Address - Phone:605-723-8970
Practice Address - Fax:605-723-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD10566OtherSD LICENSE
SD433440Medicare Oscar/Certification