Provider Demographics
NPI:1073514311
Name:ST. MICHAEL'S HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. MICHAEL'S HOSPITAL, INC.
Other - Org Name:BON HOMME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANILKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-589-2152
Mailing Address - Street 1:410 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:TYNDALL
Mailing Address - State:SD
Mailing Address - Zip Code:57066-2318
Mailing Address - Country:US
Mailing Address - Phone:605-589-2218
Mailing Address - Fax:605-589-2216
Practice Address - Street 1:410 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:TYNDALL
Practice Address - State:SD
Practice Address - Zip Code:57066-2318
Practice Address - Country:US
Practice Address - Phone:605-589-4418
Practice Address - Fax:605-589-4428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MICHAEL'S HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-09
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336L0003X
SD1001860333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5154760001OtherMEDICARE DME POS REGION D
SD8504170Medicaid
SD5154760001Medicare ID - Type Unspecified