Provider Demographics
NPI:1871725630
Name:BOWDLE HOSPITAL
Entity type:Organization
Organization Name:BOWDLE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-285-6146
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:BOWDLE
Mailing Address - State:SD
Mailing Address - Zip Code:57428-0556
Mailing Address - Country:US
Mailing Address - Phone:605-285-6146
Mailing Address - Fax:605-285-6410
Practice Address - Street 1:8001 WEST 5TH STREET
Practice Address - Street 2:
Practice Address - City:BOWDLE
Practice Address - State:SD
Practice Address - Zip Code:57428-0556
Practice Address - Country:US
Practice Address - Phone:605-285-6146
Practice Address - Fax:605-285-6410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOWDLE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570770Medicaid