Provider Demographics
NPI:1548204266
Name:ST. MICHAEL'S HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. MICHAEL'S HOSPITAL, INC.
Other - Org Name:ST. MICHAEL'S HOME HEALTH AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEURMIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-589-3341
Mailing Address - Street 1:410 WEST 16TH AVE.
Mailing Address - Street 2:
Mailing Address - City:TYNDALL
Mailing Address - State:SD
Mailing Address - Zip Code:57066-0027
Mailing Address - Country:US
Mailing Address - Phone:605-589-3341
Mailing Address - Fax:605-589-3288
Practice Address - Street 1:410 WEST 16TH AVE.
Practice Address - Street 2:
Practice Address - City:TYNDALL
Practice Address - State:SD
Practice Address - Zip Code:57066-0027
Practice Address - Country:US
Practice Address - Phone:605-589-3341
Practice Address - Fax:605-589-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48584282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0170640Medicaid
SD87033OtherHOME HEALTH AGENCY BCBS
SD0170640Medicaid