Provider Demographics
NPI:1336144021
Name:DOUGLAS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DOUGLAS COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROUWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-724-2159
Mailing Address - Street 1:708 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ARMOUR
Mailing Address - State:SD
Mailing Address - Zip Code:57313-2102
Mailing Address - Country:US
Mailing Address - Phone:605-724-2159
Mailing Address - Fax:605-724-2310
Practice Address - Street 1:708 8TH ST
Practice Address - Street 2:
Practice Address - City:ARMOUR
Practice Address - State:SD
Practice Address - Zip Code:57313-2102
Practice Address - Country:US
Practice Address - Phone:605-724-2159
Practice Address - Fax:605-724-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10526282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8Z305OtherBLUE CROSS
SD0100780Medicaid
SD5500780Medicaid
SD81305OtherBLUE CROSS
SD87049OtherBLUE CROSS
SD5500780Medicaid
SD5500780Medicaid
SD87049OtherBLUE CROSS
SDS77815Medicare ID - Type Unspecified
SD0100780Medicaid