Healthcare Provider Details

I. General information

NPI: 1720230709
Provider Name (Legal Business Name): INDIAN HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 NORTH MAIN ST
EAGLE BUTTE SD
57625-1012
US

IV. Provider business mailing address

317 NORTH MAIN ST
EAGLE BUTTE SD
57625-1012
US

V. Phone/Fax

Practice location:
  • Phone: 605-964-3007
  • Fax: 605-964-1156
Mailing address:
  • Phone: 605-964-3007
  • Fax: 605-964-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberR036258
License Number StateSD

VIII. Authorized Official

Name: JOHNNA WATT
Title or Position: DIRECTOR OF NURSING
Credential: RN, BSN
Phone: 605-964-3007