Provider Demographics
NPI:1558387076
Name:FLANDREAU SANTEE SIOUX TRIBE
Entity Type:Organization
Organization Name:FLANDREAU SANTEE SIOUX TRIBE
Other - Org Name:FLANDREAU SANTEE SIOUX TRIBAL HEALTH CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-573-4166
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:FLANDREAU
Mailing Address - State:SD
Mailing Address - Zip Code:57028-0329
Mailing Address - Country:US
Mailing Address - Phone:605-997-2642
Mailing Address - Fax:
Practice Address - Street 1:403 W BROAD AVE
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028-1630
Practice Address - Country:US
Practice Address - Phone:605-997-2642
Practice Address - Fax:605-997-2586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLANDREAU SANTEE SIOUX TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-15
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty