Provider Demographics
NPI:1417227422
Name:COTEAU DES PRAIRIES HOSPITAL
Entity Type:Organization
Organization Name:COTEAU DES PRAIRIES HOSPITAL
Other - Org Name:COTEAU DES PRAIRIES HEALTH CARE SYSTEM - HERMAN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:COYLE
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 1:204 FIFTH STREET EAST
Practice Address - Street 2:
Practice Address - City:HERMAN
Practice Address - State:MN
Practice Address - Zip Code:56248-0000
Practice Address - Country:US
Practice Address - Phone:320-677-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COTEAU DES PRAIRIES HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD60020208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5160Medicaid
ND5160Medicaid