Provider Demographics
NPI:1346539475
Name:LEWIS & CLARK SPECIALTY HOSPITAL LLC
Entity Type:Organization
Organization Name:LEWIS & CLARK SPECIALTY HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DOORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-5100
Mailing Address - Street 1:2601 FOX RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5341
Mailing Address - Country:US
Mailing Address - Phone:605-664-5300
Mailing Address - Fax:605-664-5301
Practice Address - Street 1:2601 FOX RUN PKWY
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5341
Practice Address - Country:US
Practice Address - Phone:605-664-5300
Practice Address - Fax:605-664-5301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWIS & CLARK SPECIALTY HOSPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-29
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0108070Medicaid
SD5508070Medicaid
SD430096Medicare UPIN
SD430096Medicare UPIN