1417227422 NPI number — COTEAU DES PRAIRIES HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417227422 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 - HERMAN CLINIC
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:
1417227422
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:
204 FIFTH STREET EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMAN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56248-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-677-2220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2012

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: 208D00000X , with the licence number:  60020 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5160 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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