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General NPI Number Information
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NPI Number | 1518845312
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Entity Type | Organization
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Legal Business Name | ERNEMY SWIM TRIBAL DISTRICT
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 13495 446TH AVE
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City | WAUBAY
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State | SD
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Zip | 57273-5318
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Country | US
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Telephone | 605-947-4319
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Fax | 605-947-4873
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Provider Business Mailing Address
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Address Line | PO BOX 15
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City | WAUBAY
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State | SD
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Zip | 57273-0015
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Country | US
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Telephone | 605-947-4319
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Fax | 605-947-4873
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Authorized Official
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Title or Position | ESD CHAIRPERSON
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Name | DUSTIN RAY LOCKE
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Credential |
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Telephone | 605-947-4319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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