Healthcare Provider Details

I. General information

NPI: 1962657338
Provider Name (Legal Business Name): INDIANHEALTHSERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST HWY 18 POST OFFICE BOX 1201
PINE RIDGE SD
57770-1201
US

IV. Provider business mailing address

EAST HWY 18 POST OFFICE BOX 1201
PINE RIDGE SD
57770-1201
US

V. Phone/Fax

Practice location:
  • Phone: 605-867-5131
  • Fax: 605-867-3263
Mailing address:
  • Phone: 605-867-5131
  • Fax: 605-867-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberR035667
License Number StateSD

VIII. Authorized Official

Name: WILLIAM POURIER
Title or Position: CEO
Credential:
Phone: 605-867-5131