Provider Demographics
NPI:1417051517
Name:COTEAU DES PRAIRIES HOSPITAL
Entity Type:Organization
Organization Name:COTEAU DES PRAIRIES HOSPITAL
Other - Org Name:COTEAU DES PRAIRIES HEALTH CARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:KANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-698-7647
Mailing Address - Street 1:205 ORCHARD DRIVE
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:605-698-7647
Mailing Address - Fax:605-698-4626
Practice Address - Street 1:205 ORCHARD DRIVE
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2398
Practice Address - Country:US
Practice Address - Phone:605-698-7647
Practice Address - Fax:605-698-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10565282N00000X
SD60020282N00000X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
3135OtherSIOUX VALLEY HEALTH PLAN
ND5160OtherND MEDICAID
MN617847200Medicaid
SD80064OtherBLUE CROSS
ND005160Medicaid
SD0100640Medicaid
9223773OtherDAKOTACARE
MN0466HCOOtherBLUE CROSS
03070116100OtherPRIME WEST
ND80064OtherBLUE CROSS
ND80064OtherBLUE CROSS
SD0100640Medicaid