Healthcare Provider Details

I. General information

NPI: 1578369070
Provider Name (Legal Business Name): PRAIRIE LAKES HEALTH CARE SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 1ST AVE N
CASTLEWOOD SD
57223
US

IV. Provider business mailing address

PO BOX 1210
WATERTOWN SD
57201-6210
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-7000
  • Fax: 605-882-7636
Mailing address:
  • Phone: 605-882-7000
  • Fax: 605-882-7636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TONY LEE MORRISON
Title or Position: VICE PRESIDENT, REVENUE CYCLE
Credential:
Phone: 605-328-8380