Healthcare Provider Details

I. General information

NPI: 1962559518
Provider Name (Legal Business Name): PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 1ST ST
WANBLEE SD
57577-0290
US

IV. Provider business mailing address

PO BOX 290 210 1ST ST
WANBLEE SD
57577-0290
US

V. Phone/Fax

Practice location:
  • Phone: 605-462-6155
  • Fax: 605-462-6631
Mailing address:
  • Phone: 605-462-6155
  • Fax: 605-462-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHONDA M AKERS
Title or Position: HEALTH SYSTEM SPECIALIST
Credential:
Phone: 605-867-3032