Healthcare Provider Details

I. General information

NPI: 1518062629
Provider Name (Legal Business Name): PIONEER MEMORIAL HOSPITAL AND HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 BROADWAY
CENTERVILLE SD
57014
US

IV. Provider business mailing address

PO BOX 99
CENTERVILLE SD
57014-0099
US

V. Phone/Fax

Practice location:
  • Phone: 605-563-2243
  • Fax: 605-563-3784
Mailing address:
  • Phone: 605-563-2243
  • Fax: 605-563-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number100-1834
License Number StateSD

VIII. Authorized Official

Name: THOMAS RICHTER
Title or Position: CEO
Credential:
Phone: 605-326-5161