Provider Demographics
NPI:1235302142
Name:PHS INDIAN HOSPITAL
Entity Type:Organization
Organization Name:PHS INDIAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:NEIBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:406-638-3558
Mailing Address - Street 1:10110 SOUTH 7650 EAST PHS
Mailing Address - Street 2:CROW NORTHERN CHEYENNE INDIAN
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022
Mailing Address - Country:US
Mailing Address - Phone:406-638-3558
Mailing Address - Fax:406-638-3482
Practice Address - Street 1:10110 SOUTH 7650 EAST PHS
Practice Address - Street 2:CROW NORTHERN CHEYENNE INDIAN
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3558
Practice Address - Fax:406-638-3482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHHS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20957282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access