Healthcare Provider Details

I. General information

NPI: 1932327624
Provider Name (Legal Business Name): GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 ELDERBERRY BLVD
RAPID CITY SD
57703-5970
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: 605-721-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. SUNNY COLOMBE
Title or Position: CFO
Credential: MBA
Phone: 605-721-1922