Provider Demographics
NPI:1558742098
Name:PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Entity Type:Organization
Organization Name:PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Other - Org Name:LACREEK DISTRICT CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:605-867-3032
Mailing Address - Street 1:119 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:SD
Mailing Address - Zip Code:57551-5835
Mailing Address - Country:US
Mailing Address - Phone:605-685-2880
Mailing Address - Fax:
Practice Address - Street 1:119 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:SD
Practice Address - Zip Code:57551-5835
Practice Address - Country:US
Practice Address - Phone:605-685-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-10
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center