Provider Demographics
NPI:1770958837
Name:BENNETT COUNTY RURAL HEALTH CLINIC
Entity type:Organization
Organization Name:BENNETT COUNTY RURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-685-6622
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:SD
Mailing Address - Zip Code:57551-0040
Mailing Address - Country:US
Mailing Address - Phone:605-685-1660
Mailing Address - Fax:605-685-1166
Practice Address - Street 1:102 MAJOR ALLEN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:SD
Practice Address - Zip Code:57551-6005
Practice Address - Country:US
Practice Address - Phone:605-685-1660
Practice Address - Fax:605-685-1166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENNETT COUNTY HOSPITAL AND NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-01
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10549282NC0060X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access