Healthcare Provider Details

I. General information

NPI: 1487878435
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 JACKSON ST
BURKE SD
57523-0319
US

IV. Provider business mailing address

809 JACKSON ST
BURKE SD
57523-0319
US

V. Phone/Fax

Practice location:
  • Phone: 605-775-2621
  • Fax:
Mailing address:
  • Phone: 605-775-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number10530
License Number StateSD

VIII. Authorized Official

Name: MISTIE SACHTJEN
Title or Position: CEO
Credential:
Phone: 605-775-2621