Healthcare Provider Details

I. General information

NPI: 1003999152
Provider Name (Legal Business Name): BOWDLE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 WEST 5TH STREET
BOWDLE SD
57428-0556
US

IV. Provider business mailing address

PO BOX 556
BOWDLE SD
57428-0556
US

V. Phone/Fax

Practice location:
  • Phone: 605-285-6146
  • Fax: 605-285-6410
Mailing address:
  • Phone: 605-285-6146
  • Fax: 605-285-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. JON KOSIAK
Title or Position: CEO
Credential:
Phone: 605-285-6146