Hayti Medical Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

CP000033 Issued in SD

Legal business name

HAYTI MEDICAL CLINIC

Practice address

102 Main Ave
Hayti, SD 57241-0238

Phone

(605) 783-3030

Fax

(605) 783-1320

NPI assigned

Sep 19, 2012

Last updated

Sep 19, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mitchell P. Jenner

Title

Nurse Practitioner

Phone

(605) 783-3030

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1144570995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 MAIN AVE",
            "city": "HAYTI",
            "state": "SD",
            "postal_code": "572410238",
            "telephone_number": "605-783-3030",
            "fax_number": "605-783-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 MAIN AVE",
            "city": "HAYTI",
            "state": "SD",
            "postal_code": "572410238",
            "telephone_number": "605-783-3030",
            "fax_number": "605-783-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAYTI MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "JENNER",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "605-783-3030",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "SD",
            "license": "CP000033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6820663",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Garcia Family Clinic, PLLC
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• Josephine DC Garcia, APRN BC FNP-,DNP,MD
• Hamlin School District 28-3
• Heather Lynne Hansen, M.A., CCC-SLP
• Kari Holden, PT
• Alysha Johnson
• Cheryl Keller-Knudson
• Deb Jean Lauseng, SLP
• Lois Marie Lux, SLP

• Clinic/Center in Hayti, SD
• Providers in Hayti, SD by specialty
• Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; 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.