Provider Demographics
NPI:1609453422
Name:PHILIP CLINIC
Entity Type:Organization
Organization Name:PHILIP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:PFEIFLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-859-2511
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567-0550
Mailing Address - Country:US
Mailing Address - Phone:605-859-2566
Mailing Address - Fax:605-859-2948
Practice Address - Street 1:503 W PINE ST
Practice Address - Street 2:
Practice Address - City:PHILIP
Practice Address - State:SD
Practice Address - Zip Code:57567-3300
Practice Address - Country:US
Practice Address - Phone:605-859-2566
Practice Address - Fax:605-859-2948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILIP HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5340090Medicaid