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General NPI Number Information
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NPI Number | 1710110671
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Entity Type | Organization
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Legal Business Name | SANTEE SIOUX NATION
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 110 S VISITING EAGLE ST
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City | NIOBRARA
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State | NE
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Zip | 68760-7201
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Country | US
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Telephone | 402-857-2300
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Fax | 402-857-2315
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Provider Business Mailing Address
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Address Line | 110 S VISITING EAGLE ST
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City | NIOBRARA
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State | NE
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Zip | 68760-7201
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Country | US
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Telephone | 402-857-2300
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Fax | 402-857-2315
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. MIKE HENRY
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Credential |
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Telephone | 402-857-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1445
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License Number State | NE
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