Provider Demographics
NPI:1558305243
Name:ST. MICHAEL'S HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. MICHAEL'S HOSPITAL, INC.
Other - Org Name:BON HOMME FAMILY PRACTICE - AVON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANILKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-589-2152
Mailing Address - Street 1:410 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:TYNDALL
Mailing Address - State:SD
Mailing Address - Zip Code:57066-2318
Mailing Address - Country:US
Mailing Address - Phone:605-589-2100
Mailing Address - Fax:605-589-2115
Practice Address - Street 1:410 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:TYNDALL
Practice Address - State:SD
Practice Address - Zip Code:57066-2318
Practice Address - Country:US
Practice Address - Phone:605-589-2100
Practice Address - Fax:605-589-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5340152Medicaid
SD4996776OtherRHC BCBS AVON
SD433418Medicare ID - Type UnspecifiedRHC AVON