MEDICARE: SARA JUANITA JUMPING EAGLE M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	11019	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508865007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA JUANITA JUMPING EAGLE M.D.

Provider Business Mailing Address
First Line	:	10 NORTH RIVER ROAD
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538
Country	:	US
Telephone Number	:	701-854-3831
Fax Number	:	701-854-7399

Provider Business Practice Location Address
First Line	:	10 N. RIVER RD.
Second Line	:	FORT YATES IHS HOSPITAL/CLINIC
City	:	FT. YATES
State	:	ND
Zip	:	58538
Country	:	US
Telephone Number	:	701-854-3831
Fax Number	:	701-854-7399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	12/03/2014

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