Provider Demographics
NPI:1912057274
Name:PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Entity Type:Organization
Organization Name:PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Other - Org Name:BESS SURGERY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-326-3045
Mailing Address - Street 1:315 N WASHINGTON ST
Mailing Address - Street 2:PO BOX 368
Mailing Address - City:VIBORG
Mailing Address - State:SD
Mailing Address - Zip Code:57070-0368
Mailing Address - Country:US
Mailing Address - Phone:605-326-5161
Mailing Address - Fax:605-326-5734
Practice Address - Street 1:2701 S SPRING AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4725
Practice Address - Country:US
Practice Address - Phone:605-334-1944
Practice Address - Fax:605-334-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID
=========OtherTAX ID