Healthcare Provider Details

I. General information

NPI: 1194846949
Provider Name (Legal Business Name): STANDING ROCK INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NORTH RIVER RD
FORT YATES ND
58538
US

IV. Provider business mailing address

10 NORTH RIVER RD
FORT YATES ND
58538
US

V. Phone/Fax

Practice location:
  • Phone: 701-854-3831
  • Fax: 701-854-3523
Mailing address:
  • Phone: 701-854-3831
  • Fax: 701-854-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4949
License Number StateND

VIII. Authorized Official

Name: MS. LISA GUARDIPEE
Title or Position: CEO
Credential:
Phone: 701-854-3831