1003208257 NPI number — PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL

Table of content: (NPI 1003208257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003208257 NPI number — PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003208257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 SOUTH 1ST AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTIN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-685-2800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 SOUTH 1ST AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTIN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-685-2800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
AKERS
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
HEALTH SYSTEM SPECIALIST
Authorized Official Telephone Number:
605-867-3032

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5949000 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430098 . This is a "CCN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com