Healthcare Provider Details

I. General information

NPI: 1922915420
Provider Name (Legal Business Name): FLANDREAU SANTEE SIOUX TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W BROAD AVE
FLANDREAU SD
57028-1630
US

IV. Provider business mailing address

PO BOX 329
FLANDREAU SD
57028-0329
US

V. Phone/Fax

Practice location:
  • Phone: 605-997-2642
  • Fax: 605-997-2642
Mailing address:
  • Phone: 605-997-2642
  • Fax: 605-997-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID W WALFORD
Title or Position: BILLING/CREDENTIALING SUPERVISOR
Credential:
Phone: 605-573-4166