Basic Information
| Provider Information | |||||||||
| NPI: | 1841271186 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HURON REGIONAL MEDICAL CENTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | DESMET MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 PRAIRIE AVE SW | ||||||||
| Address2: | |||||||||
| City: | DE SMET | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572312285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058543329 | ||||||||
| FaxNumber: | 6058549161 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 PRAIRIE AVE SW | ||||||||
| Address2: | |||||||||
| City: | DE SMET | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572312285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058543329 | ||||||||
| FaxNumber: | 6058549161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2005 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SINGLE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6053536200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HURON REGIONAL MEDICAL CENTER | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 50726 | SD | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 0100240 | 05 | SD | MEDICAID |