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General NPI Number Information
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NPI Number | 1578541827
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Entity Type | Organization
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Legal Business Name | MCLAUGHLIN INDIAN HEALTH SERVICE
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 701 2ND AVE EAST
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City | MC LAUGHLIN
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State | SD
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Zip | 57642-0879
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Country | US
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Telephone | 605-823-4458
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Fax | 605-823-4470
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Provider Business Mailing Address
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Address Line | PO BOX 879
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City | MC LAUGHLIN
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State | SD
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Zip | 57642-0879
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Country | US
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Telephone | 605-823-4458
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Fax | 605-823-4470
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Authorized Official
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Title or Position | ACEO
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Name | DR. RICHARD KRAFT
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Credential | MD
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Telephone | 605-823-4458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 88532
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License Number State | CO
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