MEDICARE: 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	282N00000X	General Acute Care Hospital		SD

General Provider Information

NPI Number	:	1922337716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIAN HEALTH SERVICE

Provider Business Mailing Address
First Line	:	120 GRAND BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 CANYON LAKE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3118
Country	:	US
Telephone Number	:	605-355-2500
Fax Number	:	605-355-2553

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	MISS DONNA HUBER
Credential	:
Telephone Number	:	605-355-2500

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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Directions to “INDIAN HEALTH SERVICE ” Practice Location

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