Provider Demographics
NPI:1003879958
Name:DOUGLAS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DOUGLAS COUNTY MEMORIAL HOSPITAL
Other - Org Name:PRAIRIE HEALTH CLINIC - CORSICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROUWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-946-5959
Mailing Address - Street 1:230 MAIN ST
Mailing Address - Street 2:PO BOX 22
Mailing Address - City:CORSICA
Mailing Address - State:SD
Mailing Address - Zip Code:57328
Mailing Address - Country:US
Mailing Address - Phone:605-946-5959
Mailing Address - Fax:605-946-5616
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORSICA
Practice Address - State:SD
Practice Address - Zip Code:57328
Practice Address - Country:US
Practice Address - Phone:605-946-5959
Practice Address - Fax:605-946-5616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-11
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5340310Medicaid
SD5340310Medicaid