1003825738 NPI number — COTEAU DES PRAIRIES HOSPITAL

Table of content: (NPI 1003825738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003825738 NPI number — COTEAU DES PRAIRIES HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COTEAU DES PRAIRIES HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COTEAU DES PRAIRIES HEALTH CARE SYSTEM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003825738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 ORCHARD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SISSETON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57262-2398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-698-7647
Provider Business Mailing Address Fax Number:
605-698-4626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 ORCHARD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SISSETON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57262-2398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-698-7647
Provider Business Practice Location Address Fax Number:
605-698-4626
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COYLE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
605-698-7647

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  03653 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 60020 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 275N00000X , with the licence number: 60020 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0159050 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0466HCO . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 617847200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87067 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 87067 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0171090 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5160 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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