Provider Demographics
NPI:1346734696
Name:SISSETON WAHPETON OYATE
Entity Type:Organization
Organization Name:SISSETON WAHPETON OYATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SISSETON-WAHPETON OYATE TRIBAL SECR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:605-698-3911
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:AGENCY VILLAGE
Mailing Address - State:SD
Mailing Address - Zip Code:57262
Mailing Address - Country:US
Mailing Address - Phone:605-698-3911
Mailing Address - Fax:605-698-3276
Practice Address - Street 1:12554 BIA HWY 711
Practice Address - Street 2:
Practice Address - City:AGENCY VILLAGE
Practice Address - State:SD
Practice Address - Zip Code:57262
Practice Address - Country:US
Practice Address - Phone:605-698-3911
Practice Address - Fax:605-698-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle