Provider Demographics
NPI:1023193422
Name:PHILIP HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PHILIP HEALTH SERVICES, INC.
Other - Org Name:HANS P. PETERSON MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-859-2511
Mailing Address - Street 1:503 W PINE ST
Mailing Address - Street 2:PO BOX 790
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567-3300
Mailing Address - Country:US
Mailing Address - Phone:605-859-2511
Mailing Address - Fax:605-859-3506
Practice Address - Street 1:503 W PINE ST
Practice Address - Street 2:
Practice Address - City:PHILIP
Practice Address - State:SD
Practice Address - Zip Code:57567-3300
Practice Address - Country:US
Practice Address - Phone:605-859-2511
Practice Address - Fax:605-859-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10555275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8Z319OtherBCBS PROVIDER #
SD8Z319OtherBCBS PROVIDER #