MEDICARE: FORT YATES INDIAN HEALTH SERVICE HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NR1301X	Rural Acute Care Hospital	1796	ND
2	282NC0060X	Critical Access Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	351364	OTHER	CMS CERTIFICATION NUMBER (CCN)
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609851039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT YATES INDIAN HEALTH SERVICE HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX J
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538-0527
Country	:	US
Telephone Number	:	701-854-3831
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 NORTH RIVER ROAD
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538
Country	:	US
Telephone Number	:	701-854-3831
Fax Number	:	701-854-7567

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JANA RHEA GIPP
Credential	:
Telephone Number	:	701-854-8211

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	02/04/2022

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Directions to “FORT YATES INDIAN HEALTH SERVICE HOSPITAL ” Practice Location

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