Healthcare Provider Details

I. General information

NPI: 1710995907
Provider Name (Legal Business Name): FORT THOMPSON INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 34 & 47
FORT THOMPSON SD
57339-0200
US

IV. Provider business mailing address

HWY 34 & 47
FORT THOMPSON SD
57339-0200
US

V. Phone/Fax

Practice location:
  • Phone: 605-245-1500
  • Fax: 605-245-2384
Mailing address:
  • Phone: 605-245-1500
  • Fax: 605-245-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADONNA M LONG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 605-245-1500