Healthcare Provider Details

I. General information

NPI: 1073514311
Provider Name (Legal Business Name): ST. MICHAEL'S HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 16TH AVE
TYNDALL SD
57066-2318
US

IV. Provider business mailing address

410 W 16TH AVE
TYNDALL SD
57066-2318
US

V. Phone/Fax

Practice location:
  • Phone: 605-589-4418
  • Fax: 605-589-4428
Mailing address:
  • Phone: 605-589-2218
  • Fax: 605-589-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1001860
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ASHLI DANILKO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 605-589-2152