Provider Demographics
NPI:1568416667
Name:PHILIP HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PHILIP HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-859-2511
Mailing Address - Street 1:601 CHESTNUT ST
Mailing Address - Street 2:PO BOX 460
Mailing Address - City:KADOKA
Mailing Address - State:SD
Mailing Address - Zip Code:57543-0460
Mailing Address - Country:US
Mailing Address - Phone:605-837-2257
Mailing Address - Fax:605-837-2061
Practice Address - Street 1:601 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:KADOKA
Practice Address - State:SD
Practice Address - Zip Code:57543-0460
Practice Address - Country:US
Practice Address - Phone:605-837-2257
Practice Address - Fax:605-837-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5340270Medicaid
SD0641470001Medicare NSC
SDS6Medicare PIN
SD433424Medicare Oscar/Certification