MEDICARE: GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QP2000X	Physical Therapy Clinic/Center
3	261QU0200X	Urgent Care Clinic/Center
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	291U00000X	Clinical Medical Laboratory
6	261QD0000X	Dental Clinic/Center
7	332S00000X	Hearing Aid Equipment
8	261QR0200X	Radiology Clinic/Center
9	261QP2300X	Primary Care Clinic/Center
10	261QM0850X	Adult Mental Health Clinic/Center
11	261QH0700X	Hearing and Speech Clinic/Center
12	261Q00000X	Clinic/Center
13	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1134916828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD

Provider Business Mailing Address
First Line	:	3200 CANYON LAKE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8114
Country	:	US
Telephone Number	:	605-355-2500
Fax Number	:	605-355-2517

Provider Business Practice Location Address
First Line	:	3200 CANYON LAKE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8114
Country	:	US
Telephone Number	:	605-355-2500
Fax Number	:	605-355-2517

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICIER
Name	:	ANTONIO REYES
Credential	:	MD
Telephone Number	:	605-355-2500

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	06/03/2026

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Directions to “GREAT PLAINS TRIBAL CHAIRMEN'S HEALTH BOARD ” Practice Location

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