Provider Demographics
NPI:1063630853
Name:EAGLE BUTTE INDIAN HEALTH SERVICE
Entity Type:Organization
Organization Name:EAGLE BUTTE INDIAN HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HOLLOW HORN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:605-964-3007
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:EAGLE BUTTE
Mailing Address - State:SD
Mailing Address - Zip Code:57625-1012
Mailing Address - Country:US
Mailing Address - Phone:605-964-2653
Mailing Address - Fax:
Practice Address - Street 1:330 MAPLE STREET
Practice Address - Street 2:326
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625-1012
Practice Address - Country:US
Practice Address - Phone:605-964-2653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDRO28233282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural