Provider Demographics
NPI:1609851039
Name:FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Entity Type:Organization
Organization Name:FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Other - Org Name:
Other - Org Type:
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 1:10 NORTH RIVER ROAD
Practice Address - Street 2:
Practice Address - City:FORT YATES
Practice Address - State:ND
Practice Address - Zip Code:58538
Practice Address - Country:US
Practice Address - Phone:701-854-3831
Practice Address - Fax:701-854-7567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X
ND1796282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
351364OtherCMS CERTIFICATION NUMBER (CCN)
SD5549040Medicaid
ND1459056Medicaid
SD5549040Medicaid
HSZ186Medicare PIN
350064Medicare Oscar/Certification