Healthcare Provider Details

I. General information

NPI: 1487644035
Provider Name (Legal Business Name): LEWIS & CLARK SPECIALTY HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 FOX RUN PKWY
YANKTON SD
57078-5341
US

IV. Provider business mailing address

2601 FOX RUN PKWY
YANKTON SD
57078-5341
US

V. Phone/Fax

Practice location:
  • Phone: 605-665-5100
  • Fax: 605-665-5200
Mailing address:
  • Phone: 605-665-5100
  • Fax: 605-665-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number47834
License Number StateSD

VIII. Authorized Official

Name: MR. DOUG DOORN
Title or Position: CEO
Credential:
Phone: 605-665-5100