Provider Demographics
NPI:1497347579
Name:FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Entity Type:Organization
Organization Name:FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Other - Org Name:BULLHEAD HEALTH STATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:RHEA
Authorized Official - Last Name:GIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-854-8211
Mailing Address - Street 1:PO BOX J
Mailing Address - Street 2:
Mailing Address - City:FORT YATES
Mailing Address - State:ND
Mailing Address - Zip Code:58538-0527
Mailing Address - Country:US
Mailing Address - Phone:701-854-3831
Mailing Address - Fax:
Practice Address - Street 1:102 TASUNKA STREET
Practice Address - Street 2:
Practice Address - City:BULLHEAD
Practice Address - State:SD
Practice Address - Zip Code:57621
Practice Address - Country:US
Practice Address - Phone:605-823-4991
Practice Address - Fax:605-823-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service