Provider Demographics
NPI:1144370404
Name:HURON CLINIC FOUNDATION, LTD.
Entity type:Organization
Organization Name:HURON CLINIC FOUNDATION, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR/ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-352-8384
Mailing Address - Street 1:390 KANSAS AVE SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2518
Mailing Address - Country:US
Mailing Address - Phone:605-352-8384
Mailing Address - Fax:605-352-8704
Practice Address - Street 1:390 KANSAS AVE SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2518
Practice Address - Country:US
Practice Address - Phone:605-352-8384
Practice Address - Fax:605-352-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5100160Medicaid