Healthcare Provider Details

I. General information

NPI: 1659235968
Provider Name (Legal Business Name): CROW CREEK DEPARTMENT OF PUBLIC SAFETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E. SAMBOY DRIVE 206 E. SAMBOY
FORT THOMPSON SD
57339-0409
US

IV. Provider business mailing address

PO BOX 409 206 E. SAMBOY
FORT THOMPSON SD
57339-0409
US

V. Phone/Fax

Practice location:
  • Phone: 605-245-2779
  • Fax: 605-245-2182
Mailing address:
  • Phone: 605-478-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: THOMAS WAYNE THOMPSON
Title or Position: DIRECTOR
Credential:
Phone: 605-245-2779