Healthcare Provider Details

I. General information

NPI: 1871554311
Provider Name (Legal Business Name): MOBRIDGE REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 10TH AVE WEST
MOBRIDGE SD
57601-0850
US

IV. Provider business mailing address

PO BOX 580
MOBRIDGE SD
57601-0580
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-3692
  • Fax: 605-845-8252
Mailing address:
  • Phone: 605-845-3692
  • Fax: 605-845-8252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number48404
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number48404
License Number StateSD

VIII. Authorized Official

Name: RENAE TISDALL
Title or Position: CFO
Credential:
Phone: 605-845-8164