MEDICARE: HEART HOSPITAL OF SOUTH DAKOTA LLC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	41953	SD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	80095	OTHER	SD	WELLMARK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1023003969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART HOSPITAL OF SOUTH DAKOTA LLC

Provider Business Mailing Address
First Line	:	4500 W 69TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8148
Country	:	US
Telephone Number	:	605-977-7000
Fax Number	:	605-977-7001

Provider Business Practice Location Address
First Line	:	4500 W 69TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8148
Country	:	US
Telephone Number	:	605-977-7000
Fax Number	:	605-977-7001

Authorized Official
Title or Position	:	CFO
Name	:	BRIAN PEDERSON
Credential	:
Telephone Number	:	605-977-7009

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	11/25/2025

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax: