Healthcare Provider Details

I. General information

NPI: 1053465096
Provider Name (Legal Business Name): SANTEE SIOUX TRIBE OF NEBRASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S VISITING EAGLE ST
NIOBRARA NE
68760-7201
US

IV. Provider business mailing address

110 S VISITING EAGLE ST
NIOBRARA NE
68760-7201
US

V. Phone/Fax

Practice location:
  • Phone: 402-857-2300
  • Fax: 402-857-2416
Mailing address:
  • Phone: 402-857-2300
  • Fax: 402-857-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNE

VIII. Authorized Official

Name: MR. MIKE HENRY
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 402-857-2300