Provider Demographics
NPI:1912279829
Name:CITY OF BROOKINGS
Entity Type:Organization
Organization Name:CITY OF BROOKINGS
Other - Org Name:BROOKINGS HEALTH SYSTEM WHITE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-696-9000
Mailing Address - Street 1:300 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2480
Mailing Address - Country:US
Mailing Address - Phone:605-696-9000
Mailing Address - Fax:605-696-7751
Practice Address - Street 1:302 E 5TH STREET
Practice Address - Street 2:
Practice Address - City:WHITE
Practice Address - State:SD
Practice Address - Zip Code:57276-2061
Practice Address - Country:US
Practice Address - Phone:605-696-9000
Practice Address - Fax:605-696-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD433436Medicare Oscar/Certification