MEDICARE: FORT THOMPSON INDIAN HEALTH SERVICE

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	261Q00000X	Clinic/Center

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	:	1710995907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT THOMPSON INDIAN HEALTH SERVICE

Provider Business Mailing Address
First Line	:	HWY 34 & 47
Second Line	:
City	:	FORT THOMPSON
State	:	SD
Zip	:	57339-0200
Country	:	US
Telephone Number	:	605-245-1500
Fax Number	:	605-245-2384

Provider Business Practice Location Address
First Line	:	HWY 34 & 47
Second Line	:
City	:	FORT THOMPSON
State	:	SD
Zip	:	57339-0200
Country	:	US
Telephone Number	:	605-245-1500
Fax Number	:	605-245-2384

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MADONNA M LONG
Credential	:
Telephone Number	:	605-245-1500

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	04/20/2008

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Directions to “FORT THOMPSON INDIAN HEALTH SERVICE ” Practice Location

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