Provider Demographics
NPI:1700925153
Name:COTEAU DES PRAIRIES HOSPITAL, INC
Entity Type:Organization
Organization Name:COTEAU DES PRAIRIES HOSPITAL, INC
Other - Org Name:COUTEAU DES PRIAIRES HOSPITAL & CLINIC WILMOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-698-7647
Mailing Address - Street 1:205 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2312
Mailing Address - Country:US
Mailing Address - Phone:605-698-7647
Mailing Address - Fax:605-698-3493
Practice Address - Street 1:409 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMOT
Practice Address - State:SD
Practice Address - Zip Code:57279-2214
Practice Address - Country:US
Practice Address - Phone:605-938-4351
Practice Address - Fax:605-938-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
3070116201OtherPRIMEWEST
ND05160Medicaid
0030064OtherBLUE CROSS
0030064OtherBLUE CROSS