Healthcare Provider Details

I. General information

NPI: 1902187032
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MELLETTE ST
BONESTEEL SD
57317-2110
US

IV. Provider business mailing address

PO BOX 358
BURKE SD
57523-0358
US

V. Phone/Fax

Practice location:
  • Phone: 605-654-9021
  • Fax:
Mailing address:
  • Phone: 605-775-2631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYNNE MARIE BENTZ
Title or Position: CREDENTIALING
Credential:
Phone: 605-775-2631