Provider Demographics
NPI:1730186073
Name:PLATTE COMMUNITY MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:PLATTE COMMUNITY MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURKET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-337-3364
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:GEDDES
Mailing Address - State:SD
Mailing Address - Zip Code:57342-0169
Mailing Address - Country:US
Mailing Address - Phone:605-337-3197
Mailing Address - Fax:605-337-3873
Practice Address - Street 1:322 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GEDDES
Practice Address - State:SD
Practice Address - Zip Code:57342-1046
Practice Address - Country:US
Practice Address - Phone:605-337-3197
Practice Address - Fax:605-337-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10557261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5340400Medicaid
SD433414Medicare Oscar/Certification