NPIMap

Organization Active NPI

Monument Health Network, Inc.

Doing business as Monument Health Medical Clinic-Lead Deadwood

  • Registered Dietitian
  • Deadwood, SD
National Provider Identifier
1124563655
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
MONUMENT HEALTH NETWORK, INC.
Doing business as
Monument Health Medical Clinic-Lead Deadwood
Practice address
71 Charles St
Deadwood, SD 57732
Phone
(605) 717-6431
Fax
(605) 755-7884
NPI assigned
Dec 19, 2016
Last updated
Mar 9, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MONUMENT HEALTH NETWORK, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Schmidt
Title
President Custer LD-DWD Markets
Phone
(605) 755-8094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X NU Primary

Addresses

Primary practice location

71 Charles St
Deadwood, SD 57732

Mailing address

PO Box 860013
Minneapolis, MN 55486-0013
Phone (605) 717-6431

Other identifiers 2

IdentifierTypeStateIssuer
200885OtherSDCERTIFICATE OF ACCREDITATION
214518OtherSDDEAP CERTIFICATE

Other names 1

  • Monument Health Medical Clinic-Lead Deadwood Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Black Hills Medical Cli44 organizations share this tax ID, including this one
Part of
Black Hills Medical Cli

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1482105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1124563655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860013",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860013",
            "telephone_number": "605-717-6431",
            "fax_number": "605-755-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 CHARLES ST",
            "city": "DEADWOOD",
            "state": "SD",
            "postal_code": "57732",
            "telephone_number": "605-717-6431",
            "fax_number": "605-755-7884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONUMENT HEALTH NETWORK, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONUMENT HEALTH NETWORK, INC.",
        "enumeration_date": "2016-12-19",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT CUSTER LD-DWD MARKETS",
        "authorized_official_telephone_number": "605-755-8094"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATE OF ACCREDITATION",
            "identifier": "200885",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAP CERTIFICATE",
            "identifier": "214518",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monument Health Medical Clinic-Lead Deadwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deadwood, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.