Healthcare Provider Details

I. General information

NPI: 1437188729
Provider Name (Legal Business Name): FLANDREAU SANTEE SIOUX TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W BROAD AVE
FLANDREAU SD
57028
US

IV. Provider business mailing address

PO BOX 329
FLANDREAU SD
57028-0329
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID W WALFORD
Title or Position: BILLER/ CREDENTIALING
Credential:
Phone: 650-573-5166