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General NPI Number Information
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NPI Number | 1124056742
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Entity Type | Organization
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Legal Business Name | PRAIRIE LAKES HEALTH CARE SYSTEM INC
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 401 9TH AVE NW
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City | WATERTOWN
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State | SD
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Zip | 57201-1548
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Country | US
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Telephone | 605-882-7000
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Fax | 605-882-7607
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Provider Business Mailing Address
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Address Line | 401 9TH AVE NW
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City | WATERTOWN
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State | SD
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Zip | 57201-1548
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Country | US
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Telephone | 605-882-7000
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Fax | 605-882-7607
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Authorized Official
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Title or Position | VICE PRESIDENT, REVENUE CYCLE
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Name | TONY LEE MORRISON
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Credential |
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Telephone | 605-328-8380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 10572
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License Number State | SD
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