Healthcare Provider Details

I. General information

NPI: 1356375992
Provider Name (Legal Business Name): RUTH M THOMAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOLDIER CREEK ROAD,BOX 400 ROSEBUD INDIAN HEALTH SERVICE HOSPITAL
ROSEBUD SD
57570-0400
US

IV. Provider business mailing address

PO BOX 727
ROSEBUD SD
57570-0727
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 Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1014617
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0000000054
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: