MEDICARE: PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	341600000X	Ambulance
3	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HSZ153	OTHER		PTAN PART B
2	AC0018	OTHER		ASC

General Provider Information

NPI Number	:	1497786412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 1201
Second Line	:
City	:	PINE RIDGE
State	:	SD
Zip	:	57770-1201
Country	:	US
Telephone Number	:	605-867-3032
Fax Number	:	605-867-3332

Provider Business Practice Location Address
First Line	:	EAST HIGHWAY 18
Second Line	:
City	:	PINE RIDGE
State	:	SD
Zip	:	57770-9998
Country	:	US
Telephone Number	:	605-837-3314
Fax Number	:	605-867-3332

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	RHONDA M AKERS
Credential	:
Telephone Number	:	605-867-3032

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/24/2021

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Directions to “PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL ” Practice Location

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