Organization
HAYTI MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MITCHELL P. JENNER (NURSE PRACTITIONER)
(605) 783-3030
Entity
Organization
Contact information
Practice address
102 MAIN AVE, HAYTI, SD 57241-0238
(605) 783-3030
(605) 783-1320
Mailing address
102 MAIN AVE, HAYTI, SD 57241-0238
(605) 783-3030
(605) 783-1320
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
CP000033
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6820663
—
SD
Enumeration date
09/19/2012
Last updated
09/19/2012
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