Provider Demographics
NPI:1093335333
Name:MOBRIDGE REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:MOBRIDGE REGIONAL HOSPITAL
Other - Org Name:SELBY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-845-8105
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-0580
Mailing Address - Country:US
Mailing Address - Phone:605-649-9999
Mailing Address - Fax:
Practice Address - Street 1:4401 MAIN ST
Practice Address - Street 2:
Practice Address - City:SELBY
Practice Address - State:SD
Practice Address - Zip Code:57472-2010
Practice Address - Country:US
Practice Address - Phone:605-649-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBRIDGE REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-16
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care