Provider Demographics
NPI:1255347464
Name:DOUGLAS COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:DOUGLAS COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUWER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:605-724-2151
Mailing Address - Street 1:708 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ARMOUR
Mailing Address - State:SD
Mailing Address - Zip Code:57313-2102
Mailing Address - Country:US
Mailing Address - Phone:605-724-2970
Mailing Address - Fax:605-724-2310
Practice Address - Street 1:265 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORSICA
Practice Address - State:SD
Practice Address - Zip Code:57328
Practice Address - Country:US
Practice Address - Phone:605-946-5690
Practice Address - Fax:605-946-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 333600000X
SD100-18993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2094338OtherPK
2094338OtherPK