Provider Demographics
NPI:1457191942
Name:GOLDEN HEART MEDICAL CARE PLLC
Entity type:Organization
Organization Name:GOLDEN HEART MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:605-723-4663
Mailing Address - Street 1:319 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BELLE FOURCHE
Mailing Address - State:SD
Mailing Address - Zip Code:57717-2069
Mailing Address - Country:US
Mailing Address - Phone:605-723-4663
Mailing Address - Fax:605-723-4667
Practice Address - Street 1:319 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-2069
Practice Address - Country:US
Practice Address - Phone:605-723-4663
Practice Address - Fax:605-723-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty