Healthcare Provider Details

I. General information

NPI: 1497347579
Provider Name (Legal Business Name): FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 TASUNKA STREET
BULLHEAD SD
57621
US

IV. Provider business mailing address

PO BOX J
FORT YATES ND
58538-0527
US

V. Phone/Fax

Practice location:
  • Phone: 605-823-4991
  • Fax: 605-823-2150
Mailing address:
  • Phone: 701-854-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

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