Provider Demographics
NPI:1184626962
Name:HURON CLINIC FOUNDATION LTD
Entity type:Organization
Organization Name:HURON CLINIC FOUNDATION LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-352-8691
Mailing Address - Street 1:111 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2509
Mailing Address - Country:US
Mailing Address - Phone:605-352-8691
Mailing Address - Fax:605-352-8704
Practice Address - Street 1:111 4TH ST SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2509
Practice Address - Country:US
Practice Address - Phone:605-352-8691
Practice Address - Fax:605-352-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD43D0407501291U00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001OtherTRICARE
SD5585000Medicaid
0001OtherTRICARE
SD5585000Medicaid
0510070001Medicare NSC