Provider Demographics
NPI:1649412966
Name:CHEYENNE RIVER SIOUX TRIBE
Entity Type:Organization
Organization Name:CHEYENNE RIVER SIOUX TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRIBAL HEALTH CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:605-964-0785
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:EAGLE BUTTE
Mailing Address - State:SD
Mailing Address - Zip Code:57625-0590
Mailing Address - Country:US
Mailing Address - Phone:605-964-0772
Mailing Address - Fax:
Practice Address - Street 1:18190 1ST AVE
Practice Address - Street 2:
Practice Address - City:FAITH
Practice Address - State:SD
Practice Address - Zip Code:57626-0000
Practice Address - Country:US
Practice Address - Phone:605-964-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5549330Medicaid