=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437187044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENNETT COUNTY HOSPITAL AND NURSING HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 11/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 MAJOR ALLEN ST
-----------------------------------------------------
City | MARTIN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57551-6005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-685-6622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 70
-----------------------------------------------------
City | MARTIN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57551-0070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-685-6622
-----------------------------------------------------
Fax | 605-685-1166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | IT MANAGER
-----------------------------------------------------
Name | MIKE JAGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-685-6622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 100-2050
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 100-2050
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------