Provider Demographics
NPI:1174610505
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:605-285-6391
Mailing Address - Street 1:P.O. 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:605-285-6391
Mailing Address - Fax:605-285-6391
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:605-285-6391
Practice Address - Fax:605-285-6257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0151130Medicaid
SD0151130Medicaid