Healthcare Provider Details

I. General information

NPI: 1275802241
Provider Name (Legal Business Name): ROSEBUD INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOLDIER CREEK RD
ROSEBUD SD
57570-0400
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 605-747-3245
  • Fax: 605-747-5348
Mailing address:
  • Phone: 605-747-3245
  • Fax: 605-747-5348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberF335136
License Number StateNY

VIII. Authorized Official

Name: YVONNE REYNOLDS
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 605-747-3245