Provider Demographics
NPI:1003825738
Name:COTEAU DES PRAIRIES HOSPITAL
Entity type:Organization
Organization Name:COTEAU DES PRAIRIES HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-698-4601
Mailing Address - Street 1:205 ORCHARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2398
Mailing Address - Country:US
Mailing Address - Phone:605-698-7647
Mailing Address - Fax:605-698-4626
Practice Address - Street 1:205 ORCHARD DRIVE
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2398
Practice Address - Country:US
Practice Address - Phone:605-698-7647
Practice Address - Fax:605-698-4626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COTEAU DES PRAIRIES HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN03653251E00000X
SD60020275N00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0466HCOOtherBLUE CROSS
ND5160Medicaid
ND87067OtherBLUE CROSS BLUE SHIELD
SD87067OtherBLUE CROSS BLUE SHIELD
SD0171090Medicaid
MN617847200Medicaid
SD0159050Medicaid
ND5160Medicaid