Basic Information
| Provider Information | |||||||||
| NPI: | 1679635239 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HURON REGIONAL MEDICAL CENTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | DESMET MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 160 | ||||||||
| Address2: | |||||||||
| City: | DE SMET | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572310160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058543329 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 306 PRAIRIE AVE SW | ||||||||
| Address2: | |||||||||
| City: | DE SMET | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572312285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058543329 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SINGLE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6053536200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 50726 | SD | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.