Healthcare Provider Details

I. General information

NPI: 1558742098
Provider Name (Legal Business Name): PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S 1ST AVE
MARTIN SD
57551-5835
US

IV. Provider business mailing address

119 S 1ST AVE
MARTIN SD
57551-5835
US

V. Phone/Fax

Practice location:
  • Phone: 605-685-2800
  • Fax:
Mailing address:
  • Phone: 605-685-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. RHONDA M AKERS
Title or Position: BUSINESS OFFICE MANAGER
Credential: DO
Phone: 605-867-3032