Healthcare Provider Details

I. General information

NPI: 1104971738
Provider Name (Legal Business Name): FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 PRAIRIE AVENUE
WAKPALA SD
57658-9998
US

IV. Provider business mailing address

P.O. BOX J N10 NORTH RIVER ROAD
FORT YATES ND
58538-0527
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-3092
  • Fax:
Mailing address:
  • Phone: 701-854-3831
  • Fax: 701-854-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANA RHEA GIPP
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 701-854-8211