Provider Demographics
NPI:1497046767
Name:IHS EAGLE BUTTE
Entity Type:Organization
Organization Name:IHS EAGLE BUTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:IONE
Authorized Official - Last Name:RED DOG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:605-848-2396
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:EAGLE BUTTE
Mailing Address - State:SD
Mailing Address - Zip Code:57625
Mailing Address - Country:US
Mailing Address - Phone:605-848-2396
Mailing Address - Fax:
Practice Address - Street 1:317 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625-1012
Practice Address - Country:US
Practice Address - Phone:605-964-2814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR039790282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural