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Douglas County Memorial Hospital

Organization Active NPI Clinic/Center · Armour, SD

NPI 1174516124 · NPPES record last updated Oct 19, 2007

Key facts

NPI
1174516124
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
Legal business name
DOUGLAS COUNTY MEMORIAL HOSPITAL
Practice address
708 8TH St
Armour, SD 57313-2102
Phone
(605) 724-2151
Fax
(605) 724-2310
NPI assigned
Aug 25, 2005
Organization subpart
No

Authorized official

Name
Nicole J Neugebauer, CPC
Title
Clinic Office Manager
Phone
(605) 724-2151

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 10

Organizations that report the same tax identification number in the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in SD

Rural health clinic certification: CCN 433402

Legal name
DOUGLAS COUNTY MEMORIAL HOSPITAL
Doing business as
PRAIRIE HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 9, 1998
Last certification
Oct 25, 2023
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Dec 21, 1987 in SD
Enrollment address
708 8TH St
Armour, SD 57313-2102
Related CCNs
431305

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Scott Holbeck
Individual 		Corporate Director Jan 1, 2018
Heath Robert Brouwer
Individual 		Corporate Officer
Ceo		 May 10, 1999
W-2 Managing Employee May 10, 1999
Operational/Managerial Control May 10, 1999
Joel Dean Baier
Individual 		Corporate Director Jan 1, 2018
Brad Vandenberg
Individual 		Corporate Director Jun 1, 2011
Joann Schrank
Individual 		Corporate Director Jan 1, 2009
Janet Lefers
Individual 		Corporate Director Apr 22, 2020

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Prairie Health Clinic Stickney
Stickney, SD · CCN 433425		 Rural health clinic Operational/Managerial Control Apr 1, 2006

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20041029000768 SD Part a Provider - Rural Health Clinic 7810889771 Practice locations: Armour, SD

National Provider Directory

Tax ID family
Douglas County Memorial Hospital (11 organizations share this tax ID)

Locations

301 Main St
Stickney, SD 57375
Phone (605) 732-4508

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Yes

Addresses

Primary practice location

708 8TH St
Armour, SD 57313-2102

Mailing address

708 8TH St
Armour, SD 57313-2102
Phone (605) 724-2151

Other identifiers

IdentifierTypeStateIssuer
5300600MedicaidSD

Other names

  • Prairie Health Clinic Doing business as

Other providers in Armour, SD

All providers in Armour, SD · Clinic/Center in South Dakota

Sources for this page

Verify at the official NPI Registry.