Provider Demographics
NPI:1629445390
Name:MONUMENT HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:MONUMENT HEALTH NETWORK, INC.
Other - Org Name:MONUMENT HEALTH FAMILY HEALTH EDUCATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR AMBULATORY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-644-4176
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:605-717-8920
Mailing Address - Fax:605-717-8926
Practice Address - Street 1:930 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2202
Practice Address - Country:US
Practice Address - Phone:605-717-8920
Practice Address - Fax:605-717-8926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5100140Medicaid