Provider Demographics
NPI:1538582416
Name:PRAIRIE COMMUNITY HEALTH INC
Entity type:Organization
Organization Name:PRAIRIE COMMUNITY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-466-2122
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:MC INTOSH
Mailing Address - State:SD
Mailing Address - Zip Code:57641-0195
Mailing Address - Country:US
Mailing Address - Phone:605-273-4335
Mailing Address - Fax:605-273-4360
Practice Address - Street 1:223 A ST
Practice Address - Street 2:
Practice Address - City:DUPREE
Practice Address - State:SD
Practice Address - Zip Code:57623-9998
Practice Address - Country:US
Practice Address - Phone:605-466-2122
Practice Address - Fax:605-466-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center