Provider Demographics
NPI:1033238498
Name:LOWER BRULE HEALTH CENTER
Entity Type:Organization
Organization Name:LOWER BRULE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-473-5526
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:601 GALL STREET
Mailing Address - City:LOWER BRULE
Mailing Address - State:SD
Mailing Address - Zip Code:57548-0247
Mailing Address - Country:US
Mailing Address - Phone:605-473-5526
Mailing Address - Fax:
Practice Address - Street 1:601 GALL STREET
Practice Address - Street 2:
Practice Address - City:LOWER BRULE
Practice Address - State:SD
Practice Address - Zip Code:57548-0247
Practice Address - Country:US
Practice Address - Phone:605-473-5526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD04161983291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD04161983OtherA.S.C.P.