Healthcare Provider Details

I. General information

NPI: 1609851039
Provider Name (Legal Business Name): FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NORTH RIVER ROAD
FORT YATES ND
58538
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: 701-854-7567
Mailing address:
  • Phone: 701-854-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number1796
License Number StateND

VIII. Authorized Official

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