Provider Demographics
NPI:1619540309
Name:PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Entity Type:Organization
Organization Name:PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-326-3045
Mailing Address - Street 1:512 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:SD
Mailing Address - Zip Code:57014-2225
Mailing Address - Country:US
Mailing Address - Phone:605-563-2411
Mailing Address - Fax:605-563-2060
Practice Address - Street 1:512 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:SD
Practice Address - Zip Code:57014-2225
Practice Address - Country:US
Practice Address - Phone:605-563-2411
Practice Address - Fax:605-563-2060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center