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General NPI Number Information
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NPI Number | 1629840681
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Entity Type | Organization
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Legal Business Name | SICANGU OYATE HEALTH SYSTEM
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 227 N BIA 9 - SOLDIER CREEK ROAD
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City | ROSEBUD
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State | SD
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Zip | 57570-0719
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Country | US
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Telephone | 605-747-5100
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Fax | 605-747-5412
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Provider Business Mailing Address
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Address Line | PO BOX 719
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City | ROSEBUD
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State | SD
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Zip | 57570-0719
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Country | US
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Telephone | 605-747-5100
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Fax | 605-747-5412
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | DANNY PRUE JR.
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Credential |
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Telephone | 605-222-4416
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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 |
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License Number State |
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