Provider Demographics
NPI:1629072400
Name:PLATTE COMMUNITY MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:PLATTE COMMUNITY MEMORIAL HOSPITAL INC.
Other - Org Name:PLATTE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BURKET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-337-3364
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:PLATTE
Mailing Address - State:SD
Mailing Address - Zip Code:57369-0818
Mailing Address - Country:US
Mailing Address - Phone:605-337-3364
Mailing Address - Fax:605-337-3360
Practice Address - Street 1:601 E 7TH ST
Practice Address - Street 2:STE 3
Practice Address - City:PLATTE
Practice Address - State:SD
Practice Address - Zip Code:57369-2123
Practice Address - Country:US
Practice Address - Phone:605-337-3364
Practice Address - Fax:605-337-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5340300Medicaid
SD433415Medicare Oscar/Certification
SDS30026Medicare PIN