Provider Demographics
NPI:1104255389
Name:UNION COUNTY HEALTH FOUNDATION
Entity type:Organization
Organization Name:UNION COUNTY HEALTH FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-356-3317
Mailing Address - Street 1:409 SUMMIT ST
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3735
Mailing Address - Country:US
Mailing Address - Phone:605-260-0310
Mailing Address - Fax:
Practice Address - Street 1:409 SUMMIT ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3735
Practice Address - Country:US
Practice Address - Phone:605-260-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION COUNTY HEALTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-07
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD431851Medicare Oscar/Certification