Healthcare Provider Details

I. General information

NPI: 1437221504
Provider Name (Legal Business Name): PRAIRIE COMMUNITY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 MAIN STREET
EAGLE BUTTE SD
57625
US

IV. Provider business mailing address

PO BOX 97
ISABEL SD
57633-0097
US

V. Phone/Fax

Practice location:
  • Phone: 605-964-7920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number
License Number StateSD

VIII. Authorized Official

Name: BILLIE RAE PERSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 605-466-2120