NPIMap

Organization Active NPI

Platte Community Memorial Hospital, Inc.

Doing business as White Lake Medical Clinic Avera

  • Family Medicine Physician
  • White Lake, SD
National Provider Identifier
1952074791
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PLATTE COMMUNITY MEMORIAL HOSPITAL, INC.
Doing business as
White Lake Medical Clinic Avera
Practice address
306 S Johnston St
White Lake, SD 57383-2251
Phone
(605) 337-1529
Fax
(605) 337-2670
NPI assigned
Jul 28, 2021
Last updated
Mar 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Authorized official

Name
Mark Burket
Title
Ceo
Phone
(605) 337-3364

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

306 S Johnston St
White Lake, SD 57383-2251

Mailing address

306 S Johnston St
White Lake, SD 57383-2251
Phone (605) 337-1529

Other names 1

  • White Lake Medical Clinic Avera Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Platte Community Mem Hosp7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1627430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1952074791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 S JOHNSTON ST",
            "city": "WHITE LAKE",
            "state": "SD",
            "postal_code": "573832251",
            "telephone_number": "605-337-1529",
            "fax_number": "605-337-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 S JOHNSTON ST",
            "city": "WHITE LAKE",
            "state": "SD",
            "postal_code": "573832251",
            "telephone_number": "605-337-1529",
            "fax_number": "605-337-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATTE COMMUNITY MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-28",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "BURKET",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-337-3364"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Lake Medical Clinic Avera",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "White Lake Medical Clinic Avera",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Lake, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; 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.