Healthcare Provider Details

I. General information

NPI: 1578490959
Provider Name (Legal Business Name): STANDING ROCK SIOUX TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 HWY 24
FORT YATES ND
58538
US

IV. Provider business mailing address

PO BOX D
FORT YATES ND
58538-0522
US

V. Phone/Fax

Practice location:
  • Phone: 701-854-3856
  • Fax: 701-854-7611
Mailing address:
  • Phone: 701-854-3856
  • Fax: 701-854-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: SHANTELLE CRUZ
Title or Position: THIRD PARTY BILLING SPECIALIST
Credential:
Phone: 701-391-7170