Healthcare Provider Details

I. General information

NPI: 1386739563
Provider Name (Legal Business Name): EUREKA COMMUNITY BENEVOLENT HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 9TH ST
EUREKA SD
57437-0517
US

IV. Provider business mailing address

PO BOX 517 401 9TH ST
EUREKA SD
57437-0517
US

V. Phone/Fax

Practice location:
  • Phone: 605-208-2661
  • Fax: 605-284-2054
Mailing address:
  • Phone: 605-208-2661
  • Fax: 605-284-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number282NC0060X
License Number StateSD

VIII. Authorized Official

Name: MRS. BONNIE LEE SERR
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 605-284-2661