Healthcare Provider Details

I. General information

NPI: 1053653667
Provider Name (Legal Business Name): INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26045 U.S. HWY 18
ROSEBUD SD
57570-0400
US

IV. Provider business mailing address

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 TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberRO28173
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberRN-302549
License Number StateOH

VIII. Authorized Official

Name: DONNA M MARCUS
Title or Position: NURSING SECRETARY
Credential:
Phone: 605-747-2231