Healthcare Provider Details

I. General information

NPI: 1376105452
Provider Name (Legal Business Name): GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CANYON LAKE DR
RAPID CITY SD
57702-8114
US

IV. Provider business mailing address

2611 ELDERBERRY BLVD
RAPID CITY SD
57703-5970
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-1922
  • Fax: 605-721-1932
Mailing address:
  • Phone: 605-721-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAE YOUNG
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 605-355-2500