Provider Demographics
NPI:1235133109
Name:PLATTE COMMUNITY MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:PLATTE COMMUNITY MEMORIAL HOSPITAL INC
Other - Org Name:PLATTE HEALTH CENTER /AVERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKET
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:605-337-3364
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:PLATTE
Mailing Address - State:SD
Mailing Address - Zip Code:57369-0200
Mailing Address - Country:US
Mailing Address - Phone:605-337-3364
Mailing Address - Fax:605-337-2670
Practice Address - Street 1:601 E 7TH ST
Practice Address - Street 2:
Practice Address - City:PLATTE
Practice Address - State:SD
Practice Address - Zip Code:57369-2123
Practice Address - Country:US
Practice Address - Phone:605-337-3364
Practice Address - Fax:605-337-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10557282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5500260Medicaid
SD0100260Medicaid
SD0100260Medicaid