Healthcare Provider Details

I. General information

NPI: 1003879958
Provider Name (Legal Business Name): DOUGLAS COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAIN ST
CORSICA SD
57328
US

IV. Provider business mailing address

230 MAIN ST PO BOX 22
CORSICA SD
57328
US

V. Phone/Fax

Practice location:
  • Phone: 605-946-5959
  • Fax: 605-946-5616
Mailing address:
  • Phone: 605-946-5959
  • Fax: 605-946-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateSD

VIII. Authorized Official

Name: HEATH R BROUWER
Title or Position: CEO
Credential:
Phone: 605-946-5959