Provider Demographics
NPI:1992702435
Name:CITY OF MITCHELL
Entity type:Organization
Organization Name:CITY OF MITCHELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATHKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-995-8420
Mailing Address - Street 1:612 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2620
Mailing Address - Country:US
Mailing Address - Phone:605-995-8479
Mailing Address - Fax:605-995-8054
Practice Address - Street 1:201 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2620
Practice Address - Country:US
Practice Address - Phone:605-995-8400
Practice Address - Fax:605-995-8486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF MITCHELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-30
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0813416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9010860Medicaid
MN924692400Medicaid
SD0007540OtherBLUE CROSS OF SD
SD24812OtherSIOUX VALLEY HEALTH PLAN
SD9176902OtherDAKOTA CARE
SD0007540OtherBLUE CROSS OF SD
SD9176902OtherDAKOTA CARE
SDB69221Medicare UPIN
1992702435Medicare UPIN
S7540Medicare PIN