Provider Demographics
NPI:1275515579
Name:CITY OF BROOKINGS
Entity Type:Organization
Organization Name:CITY OF BROOKINGS
Other - Org Name:BROOKINGS HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-696-9000
Mailing Address - Street 1:300 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2474
Mailing Address - Country:US
Mailing Address - Phone:605-696-9000
Mailing Address - Fax:605-696-7758
Practice Address - Street 1:300 22ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2474
Practice Address - Country:US
Practice Address - Phone:605-696-9000
Practice Address - Fax:605-696-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10529282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0100080Medicaid
SD5500080Medicaid
SD0100080Medicaid