Healthcare Provider Details

I. General information

NPI: 1215125075
Provider Name (Legal Business Name): LOWER BRULE SIOUX TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 OYATE CIR
LOWER BRULE SD
57548-8500
US

IV. Provider business mailing address

187 OYATE CIR
LOWER BRULE SD
57548-8500
US

V. Phone/Fax

Practice location:
  • Phone: 605-473-8000
  • Fax:
Mailing address:
  • Phone: 605-473-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateSD

VIII. Authorized Official

Name: MR. GREG MILLER
Title or Position: DIRECTOR
Credential:
Phone: 605-473-8000