Healthcare Provider Details

I. General information

NPI: 1144393182
Provider Name (Legal Business Name): VA BLACK HILLS HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

IV. Provider business mailing address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

V. Phone/Fax

Practice location:
  • Phone: 605-720-7068
  • Fax: 605-347-7204
Mailing address:
  • Phone: 605-720-7068
  • Fax: 605-347-7204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number15800
License Number StatePR

VIII. Authorized Official

Name: DR. MARCEL CLAUDE LACOSTE
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 605-720-7068