Provider Demographics
NPI:1609013317
Name:DOUGLAS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DOUGLAS COUNTY MEMORIAL HOSPITAL
Other - Org Name:PRAIRIE HEALTH CLINIC WAGNER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CPC, CPC-H
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEUGEBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-724-2151
Mailing Address - Street 1:310 W SD HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:WAGNER
Mailing Address - State:SD
Mailing Address - Zip Code:57380-9304
Mailing Address - Country:US
Mailing Address - Phone:605-384-4577
Mailing Address - Fax:
Practice Address - Street 1:310 W SD HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380-9304
Practice Address - Country:US
Practice Address - Phone:605-724-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health