Provider Demographics
NPI:1255477162
Name:COTEAU DES PRAIRIES HOSPITAL
Entity Type:Organization
Organization Name:COTEAU DES PRAIRIES HOSPITAL
Other - Org Name:CDP HEALTH CARE SYSTEM-BROWNS VALLEY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-698-7647
Mailing Address - Street 1:205 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2398
Mailing Address - Country:US
Mailing Address - Phone:605-698-7681
Mailing Address - Fax:605-698-3493
Practice Address - Street 1:404 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:BROWNS VALLEY
Practice Address - State:MN
Practice Address - Zip Code:56219
Practice Address - Country:US
Practice Address - Phone:320-695-2526
Practice Address - Fax:320-695-2106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COTEAU DES PRAIRIES HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD60020261Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5160Medicaid
MN49082COOtherBLUE CROSS
03070116200OtherPRIMEWEST
ND05160Medicaid
03070116200OtherPRIMEWEST
ND5160Medicaid