Provider Demographics
NPI:1700838117
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:
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 1:503 W PINE ST
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567-3300
Mailing Address - Country:US
Mailing Address - Phone:605-859-2566
Mailing Address - Fax:605-859-2948
Practice Address - Street 1:503 W PINE ST
Practice Address - Street 2:
Practice Address - City:PHILIP
Practice Address - State:SD
Practice Address - Zip Code:57567-3300
Practice Address - Country:US
Practice Address - Phone:605-859-2566
Practice Address - Fax:605-859-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5340090Medicaid
SD0641470001Medicare NSC
SD5340090Medicaid
SDS6Medicare PIN