Provider Demographics
NPI:1114935012
Name:CAMPBELL COUNTY CLINIC
Entity Type:Organization
Organization Name:CAMPBELL COUNTY CLINIC
Other - Org Name:LINTON HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:R
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-254-4511
Mailing Address - Street 1:208 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HERREID
Mailing Address - State:SD
Mailing Address - Zip Code:57632
Mailing Address - Country:US
Mailing Address - Phone:605-437-2304
Mailing Address - Fax:605-437-2678
Practice Address - Street 1:208 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HERREID
Practice Address - State:SD
Practice Address - Zip Code:57632
Practice Address - Country:US
Practice Address - Phone:605-437-2304
Practice Address - Fax:605-437-2678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5300092Medicaid
SD5300092Medicaid