Provider Demographics
NPI:1669458899
Name:SACRED HEART RURAL HEALTH CLINICS
Entity Type:Organization
Organization Name:SACRED HEART RURAL HEALTH CLINICS
Other - Org Name:AVERA HOLT COUNTY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-668-8322
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 E JOHN ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1355
Practice Address - Country:US
Practice Address - Phone:402-336-4113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART HEALTH SERVICES D/B/A AVERA SACRED HEART HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-20
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5805604OtherAETNA
NE9237769OtherDAKOTA CARE
NE=========11Medicaid
NE=========OtherTRICARE
NE5805604OtherAETNA
NE=========11Medicaid
NE098792Medicare PIN
NE=========OtherNEBRASKA BCBS
NE5805604OtherAETNA