Provider Demographics
NPI:1629840681
Name:SICANGU OYATE HEALTH SYSTEM
Entity Type:Organization
Organization Name:SICANGU OYATE HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:605-222-4416
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0719
Mailing Address - Country:US
Mailing Address - Phone:605-747-5100
Mailing Address - Fax:605-747-5412
Practice Address - Street 1:227 N BIA 9 - SOLDIER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0719
Practice Address - Country:US
Practice Address - Phone:605-747-5100
Practice Address - Fax:605-747-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center