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General NPI Number Information
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NPI Number | 1144393182
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Entity Type | Organization
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Legal Business Name | VA BLACK HILLS HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 113 COMANCHE RD
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City | FORT MEADE
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State | SD
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Zip | 57741-1002
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Country | US
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Telephone | 605-720-7068
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Fax | 605-347-7204
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Provider Business Mailing Address
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Address Line | 113 COMANCHE RD
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City | FORT MEADE
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State | SD
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Zip | 57741-1002
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Country | US
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Telephone | 605-720-7068
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Fax | 605-347-7204
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. MARCEL CLAUDE LACOSTE
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Credential | M.D.
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Telephone | 605-720-7068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 15800
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License Number State | PR
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