Provider Demographics
NPI:1063516342
Name:COTEAU DES PRAIRIES HOSPITAL,INC
Entity type:Organization
Organization Name:COTEAU DES PRAIRIES HOSPITAL,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-698-4601
Mailing Address - Street 1:205 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2312
Mailing Address - Country:US
Mailing Address - Phone:605-698-7647
Mailing Address - Fax:605-698-4626
Practice Address - Street 1:205 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2312
Practice Address - Country:US
Practice Address - Phone:605-698-7647
Practice Address - Fax:605-698-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10565282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5500640Medicaid
MN617847200Medicaid