Provider Demographics
NPI:1952074791
Name:PLATTE COMMUNITY MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:PLATTE COMMUNITY MEMORIAL HOSPITAL, INC.
Other - Org Name:WHITE LAKE MEDICAL CLINIC AVERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-337-3364
Mailing Address - Street 1:306 S JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57383-2251
Mailing Address - Country:US
Mailing Address - Phone:605-337-1529
Mailing Address - Fax:605-337-2670
Practice Address - Street 1:306 S JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:SD
Practice Address - Zip Code:57383-2251
Practice Address - Country:US
Practice Address - Phone:605-337-1529
Practice Address - Fax:605-337-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty