Healthcare Provider Details

I. General information

NPI: 1952074791
Provider Name (Legal Business Name): PLATTE COMMUNITY MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S JOHNSTON ST
WHITE LAKE SD
57383-2251
US

IV. Provider business mailing address

306 S JOHNSTON ST
WHITE LAKE SD
57383-2251
US

V. Phone/Fax

Practice location:
  • Phone: 605-337-1529
  • Fax: 605-337-2670
Mailing address:
  • Phone: 605-337-1529
  • Fax: 605-337-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK BURKET
Title or Position: CEO
Credential:
Phone: 605-337-3364