Provider Demographics
NPI:1558360388
Name:MARSHALL COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MARSHALL COUNTY MEMORIAL HOSPITAL
Other - Org Name:MARSHALL COUNTY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOSNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-448-2253
Mailing Address - Street 1:413 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BRITTON
Mailing Address - State:SD
Mailing Address - Zip Code:57430-2274
Mailing Address - Country:US
Mailing Address - Phone:605-448-2253
Mailing Address - Fax:605-448-2304
Practice Address - Street 1:413 9TH ST
Practice Address - Street 2:
Practice Address - City:BRITTON
Practice Address - State:SD
Practice Address - Zip Code:57430-2274
Practice Address - Country:US
Practice Address - Phone:605-448-2253
Practice Address - Fax:605-448-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5500190Medicaid
SD0100190Medicaid
SD5500190Medicaid