Provider Demographics
NPI:1902280837
Name:MARSHALL COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MARSHALL COUNTY MEMORIAL HOSPITAL
Other - Org Name:MARSHALL COUNTY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROEHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-448-1125
Mailing Address - Street 1:415 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BRITTON
Mailing Address - State:SD
Mailing Address - Zip Code:57430-2274
Mailing Address - Country:US
Mailing Address - Phone:605-448-5953
Mailing Address - Fax:
Practice Address - Street 1:415 9TH ST
Practice Address - Street 2:
Practice Address - City:BRITTON
Practice Address - State:SD
Practice Address - Zip Code:57430
Practice Address - Country:US
Practice Address - Phone:605-448-5953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD433441Medicare Oscar/Certification