Healthcare Provider Details

I. General information

NPI: 1477942878
Provider Name (Legal Business Name): PLATTE COMMUNITY MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2015
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: 605-249-2344
Mailing address:
  • Phone: 605-337-1529
  • Fax: 605-249-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number10557
License Number StateSD

VIII. Authorized Official

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