Provider Demographics
NPI:1801989967
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:PRESIDENT/CEO
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:605-668-8322
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 1:25410 PARK AVE
Practice Address - Street 2:APARTMENT E
Practice Address - City:NIOBRARA
Practice Address - State:NE
Practice Address - Zip Code:68760-7044
Practice Address - Country:US
Practice Address - Phone:402-857-3398
Practice Address - Fax:402-857-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE921087OtherDAKOTACARE
NE10025008100Medicaid
NE10025008100Medicaid
NE10025008100Medicaid
NE0747440004Medicare NSC