Provider Demographics
NPI:1912916438
Name:LINTON HOSPITAL
Entity Type:Organization
Organization Name:LINTON HOSPITAL
Other - Org Name:CAMPBELL COUNTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-254-4511
Mailing Address - Street 1:517 AVE B
Mailing Address - Street 2:
Mailing Address - City:POLLICK
Mailing Address - State:SD
Mailing Address - Zip Code:57648
Mailing Address - Country:US
Mailing Address - Phone:605-889-2376
Mailing Address - Fax:
Practice Address - Street 1:517 AVE B
Practice Address - Street 2:
Practice Address - City:POLLICK
Practice Address - State:SD
Practice Address - Zip Code:57648
Practice Address - Country:US
Practice Address - Phone:605-889-2376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5300382Medicaid
SD5300382Medicaid