Healthcare Provider Details

I. General information

NPI: 1386834661
Provider Name (Legal Business Name): PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W PIONEER
VIBORG SD
57070-0337
US

IV. Provider business mailing address

PO BOX 337
VIBORG SD
57070-0337
US

V. Phone/Fax

Practice location:
  • Phone: 605-326-5201
  • Fax: 605-326-5196
Mailing address:
  • Phone: 605-326-5201
  • Fax: 605-326-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateSD

VIII. Authorized Official

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