Healthcare Provider Details

I. General information

NPI: 1427597392
Provider Name (Legal Business Name): FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N RIVER ROAD
FT. YATES ND
58528
US

IV. Provider business mailing address

PO BOX J
FORT YATES ND
58538-0527
US

V. Phone/Fax

Practice location:
  • Phone: 701-854-3453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JANA GIPP
Title or Position: CEO
Credential:
Phone: 701-854-8211