Provider Demographics
NPI:1649417072
Name:SISSETON WAHPETON HEALTH CARE CENTER
Entity Type:Organization
Organization Name:SISSETON WAHPETON HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE/AMBULATORY CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:BIRNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN NURSE
Authorized Official - Phone:605-698-7606
Mailing Address - Street 1:100 LAKE TRAVERSE DR
Mailing Address - Street 2:SISSETON WAHPETON HEALTH CARE CENTER
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-7046
Mailing Address - Country:US
Mailing Address - Phone:605-698-7606
Mailing Address - Fax:
Practice Address - Street 1:100 LAKE TRAVERSE DR
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-7046
Practice Address - Country:US
Practice Address - Phone:605-698-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDRO28333261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center