MEDICARE: GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QU0200X	Urgent Care Clinic/Center
2	3336C0002X	Clinic Pharmacy
3	176B00000X	Midwife
4	261Q00000X	Clinic/Center
5	333600000X	Pharmacy

General Provider Information

NPI Number	:	1376105452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD

Provider Business Mailing Address
First Line	:	2611 ELDERBERRY BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-5970
Country	:	US
Telephone Number	:	605-721-1922
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 CANYON LAKE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8114
Country	:	US
Telephone Number	:	605-721-1922
Fax Number	:	605-721-1932

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT SPECIALIST
Name	:	RAE YOUNG
Credential	:
Telephone Number	:	605-355-2500

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	06/03/2026

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