Healthcare Provider Details

I. General information

NPI: 1003099508
Provider Name (Legal Business Name): PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N. WASHINGTON ST
VIBORG SD
57070-0368
US

IV. Provider business mailing address

PO BOX 368
VIBORG SD
57070-0368
US

V. Phone/Fax

Practice location:
  • Phone: 605-326-5161
  • Fax: 605-326-4057
Mailing address:
  • Phone: 605-326-5161
  • Fax: 605-326-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5102090
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: GEORGIA C. POKORNEY
Title or Position: CEO
Credential:
Phone: 605-326-5161