Provider Demographics
NPI:1962584037
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:
Authorized Official - First Name:PAMELA
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:STE 2
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3700
Mailing Address - Country:US
Mailing Address - Phone:605-668-8601
Mailing Address - Fax:605-668-8605
Practice Address - Street 1:1000 W 4TH ST
Practice Address - Street 2:STE 2
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3700
Practice Address - Country:US
Practice Address - Phone:605-668-8601
Practice Address - Fax:605-668-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD172213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6800550Medicaid
SD6800550Medicaid
NE=========03Medicaid
0747440003Medicare NSC
SD6800550Medicaid
U68378Medicare UPIN