Healthcare Provider Details

I. General information

NPI: 1619540309
Provider Name (Legal Business Name): PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 BROADWAY ST
CENTERVILLE SD
57014-2225
US

IV. Provider business mailing address

512 BROADWAY ST
CENTERVILLE SD
57014-2225
US

V. Phone/Fax

Practice location:
  • Phone: 605-563-2411
  • Fax: 605-563-2060
Mailing address:
  • Phone: 605-563-2411
  • Fax: 605-563-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONYA RUDD
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 605-326-3045