Healthcare Provider Details

I. General information

NPI: 1336286798
Provider Name (Legal Business Name): FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6998 WEASEL STREET
CANNONBALL ND
58528
US

IV. Provider business mailing address

PO BOX J
FORT YATES ND
58538-0527
US

V. Phone/Fax

Practice location:
  • Phone: 701-854-3831
  • Fax: 701-854-7411
Mailing address:
  • Phone: 701-854-3831
  • Fax: 701-854-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANA RHEA GIPP
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 701-854-8211