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General NPI Number Information
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NPI Number | 1932824331
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Entity Type | Organization
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Legal Business Name | OGLALA SIOUX TRIBE
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Dates
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Enumeration Date | 10/07/2022
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 1588 US-18
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City | PINE RIDGE
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State | SD
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Zip | 57770
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Country | US
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Telephone | 214-738-8707
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Fax | 866-781-9370
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Provider Business Mailing Address
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Address Line | 1588 US-18
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City | PINE RIDGE
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State | SD
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Zip | 57770
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Country | US
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Telephone | 214-738-8707
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Fax | 866-781-9370
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN KILLER
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Credential |
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Telephone | 605-864-8487
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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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