Provider Demographics
NPI:1306269287
Name:PRAIRIE COMMUNITY HEALTH INC.
Entity type:Organization
Organization Name:PRAIRIE COMMUNITY HEALTH INC.
Other - Org Name:<UNAVAIL>
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 97
Mailing Address - Street 2:118 N MAIN
Mailing Address - City:ISABEL
Mailing Address - State:SD
Mailing Address - Zip Code:57633-0097
Mailing Address - Country:US
Mailing Address - Phone:605-466-2122
Mailing Address - Fax:605-466-2504
Practice Address - Street 1:223 A STREET
Practice Address - Street 2:
Practice Address - City:DUPREE
Practice Address - State:SD
Practice Address - Zip Code:57623-9999
Practice Address - Country:US
Practice Address - Phone:605-466-2122
Practice Address - Fax:605-466-2504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE COMMUNITY HEALTH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty