MEDICARE: FORT YATES IHS 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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1841407418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT YATES IHS HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 607
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538-0607
Country	:	US
Telephone Number	:	701-854-3777
Fax Number	:

Provider Business Practice Location Address
First Line	:	N 10 RIVER ROAD
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538-0527
Country	:	US
Telephone Number	:	701-854-3831
Fax Number	:

Authorized Official
Title or Position	:	RADIOLOGY MANAGER
Name	:	MRS. DEBORAH JEAN VOLK
Credential	:	DIAGRAD TECHNOLOGIST
Telephone Number	:	701-854-3831

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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