Healthcare Provider Details

I. General information

NPI: 1710037288
Provider Name (Legal Business Name): FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 EAST 6TH STREET
MCLAUGHLIN SD
57642-0879
US

IV. Provider business mailing address

PO BOX 879
MCLAUGHLIN SD
57642-0879
US

V. Phone/Fax

Practice location:
  • Phone: 605-823-4458
  • Fax: 605-823-2016
Mailing address:
  • Phone: 605-823-4458
  • Fax: 605-823-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRINA LOU FISCHER
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 605-823-2615