Provider Demographics
NPI:1295758266
Name:ST BENEDICT HEALTH CENTER
Entity type:Organization
Organization Name:ST BENEDICT HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-928-3311
Mailing Address - Street 1:401 W GLYNN DR
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-9605
Mailing Address - Country:US
Mailing Address - Phone:605-928-7961
Mailing Address - Fax:605-928-4417
Practice Address - Street 1:401 W GLYNN DR
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366-9605
Practice Address - Country:US
Practice Address - Phone:605-928-7961
Practice Address - Fax:605-928-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0007353OtherWELLMARK PARKSTON CLINIC
SD5340070Medicaid
SD5340070Medicaid
SD0007353OtherWELLMARK PARKSTON CLINIC
SDS7353Medicare PIN