Provider Demographics
NPI:1255477162
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 DR
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:605-698-7681
Mailing Address - Fax:605-698-3493
Practice Address - Street 1:404 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:BROWNS VALLEY
Practice Address - State:MN
Practice Address - Zip Code:56219
Practice Address - Country:US
Practice Address - Phone:320-695-2526
Practice Address - Fax:320-695-2106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COTEAU DES PRAIRIES HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD60020261QR1300X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
03070116200OtherPRIMEWEST
MN49082COOtherBLUE CROSS
ND05160Medicaid
ND5160Medicaid
03070116200OtherPRIMEWEST
ND5160Medicaid