Provider Demographics
NPI:1194185017
Name:INDIAN HEALTH SERVICE
Entity Type:Organization
Organization Name:INDIAN HEALTH SERVICE
Other - Org Name:INDIAN HEALTH SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-747-3310
Mailing Address - Street 1:400 SOLDIER CREEK ROAD
Mailing Address - Street 2:POB 400
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0400
Mailing Address - Country:US
Mailing Address - Phone:605-747-2231
Mailing Address - Fax:605-747-2216
Practice Address - Street 1:SOLDIER CREEK ROAD
Practice Address - Street 2:POB 400
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0400
Practice Address - Country:US
Practice Address - Phone:605-747-2231
Practice Address - Fax:605-747-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD28211100AMedicaid
NE47526Medicaid
SDPO08936Medicaid
FLRN9197861Medicaid
SDRO281173Medicaid
SDRO402267Medicaid
SDRO43498Medicaid