Provider Demographics
NPI:1669616496
Name:SACRED HEART RURAL HEALTH CLINICS
Entity type:Organization
Organization Name:SACRED HEART RURAL HEALTH CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-668-8000
Mailing Address - Street 1:1000 W 4TH ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3730
Mailing Address - Country:US
Mailing Address - Phone:605-655-1201
Mailing Address - Fax:605-655-1210
Practice Address - Street 1:409 SUMMIT ST
Practice Address - Street 2:SUITE 2800
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3734
Practice Address - Country:US
Practice Address - Phone:605-665-6820
Practice Address - Fax:605-665-6821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S8545Medicare PIN