Provider Demographics
NPI:1457328841
Name:MOBRIDGE REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:MOBRIDGE REGIONAL HOSPITAL
Other - Org Name:WEST RIVER HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:TISDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-845-8164
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:MC LAUGHLIN
Mailing Address - State:SD
Mailing Address - Zip Code:57642-0520
Mailing Address - Country:US
Mailing Address - Phone:605-823-4253
Mailing Address - Fax:
Practice Address - Street 1:103 1ST AVE EAST
Practice Address - Street 2:
Practice Address - City:MC LAUGHLIN
Practice Address - State:SD
Practice Address - Zip Code:57642-0520
Practice Address - Country:US
Practice Address - Phone:605-823-4253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5300702Medicaid
SD433430Medicare Oscar/Certification