Healthcare Provider Details

I. General information

NPI: 1790955128
Provider Name (Legal Business Name): ROSEBUD INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOLDIER CREEK ROAD
ROSEBUD SD
57570-0400
US

IV. Provider business mailing address

PO BOX 400 400 SOLDIER CREEK ROAD
ROSEBUD SD
57570-0400
US

V. Phone/Fax

Practice location:
  • Phone: 605-747-2231
  • Fax: 605-747-2216
Mailing address:
  • Phone: 605-747-2231
  • Fax: 605-747-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHEY WILSON
Title or Position: ACTING CEO
Credential:
Phone: 605-747-2231