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General NPI Number Information
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NPI Number | 1861827743
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Entity Type | Organization
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Legal Business Name | STANDING ROCK SIOUX TRIBE
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 139 PROPOSAL AVE STANDING ROCK SIOUX TRIBE
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City | FORT YATES
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State | ND
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Zip | 58538
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Country | US
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Telephone | 701-854-8500
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Fax | 701-854-8530
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Provider Business Mailing Address
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Address Line | P.O. BOX D
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City | FORT YATES
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State | ND
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Zip | 58538
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Country | US
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Telephone | 701-854-8500
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Fax | 701-854-8530
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Authorized Official
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Title or Position | COMMITTE CHAIRMAN OF THE HEALTH EDU
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Name | JESSE BRIAN TAKEN ALIVE
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Credential |
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Telephone | 701-854-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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