Healthcare Provider Details

I. General information

NPI: 1174653752
Provider Name (Legal Business Name): PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/25/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 1ST ST
WANBLEE SD
57577
US

IV. Provider business mailing address

3120 SOLUTIONS CTR
CHICAGO IL
60677-3001
US

V. Phone/Fax

Practice location:
  • Phone: 605-462-6155
  • Fax: 605-462-6551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES CUMMINGS
Title or Position: PHARMACY PROGRAM SPECIALIST
Credential: PHARMD
Phone: 405-951-6086