Provider Demographics
NPI:1437187044
Name:BENNETT COUNTY HOSPITAL AND NURSING HOME
Entity Type:Organization
Organization Name:BENNETT COUNTY HOSPITAL AND NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-685-6622
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:SD
Mailing Address - Zip Code:57551-0070
Mailing Address - Country:US
Mailing Address - Phone:605-685-6622
Mailing Address - Fax:605-685-1166
Practice Address - Street 1:102 MAJOR ALLEN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:SD
Practice Address - Zip Code:57551-6005
Practice Address - Country:US
Practice Address - Phone:605-685-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261QR1300X, 282NC0060X
SD100-2050333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9001122Medicaid
SD9011382Medicaid
SD5500790Medicaid
SD81314OtherBLUE CROSS
SD9550312Medicaid
SD0159320Medicaid
SD0006944OtherBLUE CROSS
SD0150180Medicaid
SD0100790Medicaid
SD0170792Medicaid
SD5500790Medicaid
SD0150180Medicaid
SD9001122Medicaid
SD43Z314Medicare Oscar/Certification
SD0006944OtherBLUE CROSS
SD433442Medicare Oscar/Certification