Provider Demographics
NPI:1629474549
Name:ROSEBUD IHS HOSPITA;L
Entity Type:Organization
Organization Name:ROSEBUD IHS HOSPITA;L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-747-2231
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:SOLDER CREEK ROAD
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57555
Mailing Address - Country:US
Mailing Address - Phone:605-747-3247
Mailing Address - Fax:605-747-2216
Practice Address - Street 1:SOLDER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570
Practice Address - Country:US
Practice Address - Phone:605-747-3247
Practice Address - Fax:605-747-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9293548282N00000X
MO2013038502282N00000X
SDR040431282N00000X
ININ2821110A282N00000X
SDR04184242282NR1301X
WI78464-30282NR1301X
MO2013025569282NR1301X
SDRO42551282NR1301X
PR36397282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013025569OtherNPI
MO2013038502OtherNPI
SDR040431OtherNPI
SDR042551OtherNPI
WI78464-30OtherNPI
FLRN9293548OtherNPI
PR36397OtherNPI
ININ2821110AOtherNPI
SDR041842OtherNPI