Provider Demographics
NPI:1457486045
Name:CROW CREEK SIOUX TRIBE
Entity Type:Organization
Organization Name:CROW CREEK SIOUX TRIBE
Other - Org Name:CROW CREEK SIOUX AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COMET FLYING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-245-2779
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:206 EAST SAMBOY
Mailing Address - City:FORT THOMPSON
Mailing Address - State:SD
Mailing Address - Zip Code:57339-0409
Mailing Address - Country:US
Mailing Address - Phone:605-245-2779
Mailing Address - Fax:605-245-2182
Practice Address - Street 1:206 EAST SAMBOY
Practice Address - Street 2:
Practice Address - City:FORT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339-0409
Practice Address - Country:US
Practice Address - Phone:605-245-2779
Practice Address - Fax:605-245-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD01413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDW90429Medicare UPIN
SDS99220Medicare ID - Type Unspecified