Provider Demographics
NPI:1790367340
Name:WINNER REGIONAL HEALTH CLINIC
Entity Type:Organization
Organization Name:WINNER REGIONAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-842-7299
Mailing Address - Street 1:745 EAST 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2677
Mailing Address - Country:US
Mailing Address - Phone:605-842-7175
Mailing Address - Fax:605-842-7310
Practice Address - Street 1:745 EAST 8TH STREET
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2677
Practice Address - Country:US
Practice Address - Phone:605-842-2626
Practice Address - Fax:605-842-7310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINNER REGIONAL HEALTHCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty