NPIMap

Organization Active NPI

Mobridge Regional Hospital

  • Assisted Living Facility
  • Mobridge, SD
National Provider Identifier
1710029608
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
48404 Issued in SD
Legal business name
MOBRIDGE REGIONAL HOSPITAL
Practice address
1401 10TH Ave W
Mobridge, SD 57601-1106
Phone
(605) 845-3692
Fax
(605) 845-8252
NPI assigned
Feb 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Renae Lee Tisdall
Title
Chief Financial Officer
Phone
(605) 845-3692

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 48404 SD Primary

Addresses

Primary practice location

1401 10TH Ave W
Mobridge, SD 57601-1106

Mailing address

1401 10TH Ave W
Mobridge, SD 57601-1106
Phone (605) 845-3692

Other identifiers 1

IdentifierTypeStateIssuer
9571520MedicaidSD

Other names 1

  • Prairie Sunset Village Other name

National Provider Directory

National Provider Directory
Tax ID family
Mobridge Comm Hosp Ee9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710029608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 10TH AVE W",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576011106",
            "telephone_number": "605-845-3692",
            "fax_number": "605-845-8252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 10TH AVE W",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576011106",
            "telephone_number": "605-845-3692",
            "fax_number": "605-845-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBRIDGE REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TISDALL",
        "authorized_official_first_name": "RENAE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "605-845-3692",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SD",
            "license": "48404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9571520",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Sunset Village",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mobridge, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.