Healthcare Provider Details

I. General information

NPI: 1881719425
Provider Name (Legal Business Name): LOWER BRULE HEALTH CENTER IHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GALL STREET
LOWER BRULE SD
57548-0248
US

IV. Provider business mailing address

PO BOX 248 601 GALL STREET
LOWER BRULE SD
57548-0248
US

V. Phone/Fax

Practice location:
  • Phone: 605-473-5526
  • Fax: 605-473-0828
Mailing address:
  • Phone: 605-473-5526
  • Fax: 605-473-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EYVONNE T REKOW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 605-473-5526