Provider Demographics
NPI:1710037288
Name:FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Entity Type:Organization
Organization Name:FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Other - Org Name:MCLAUGHLIN INDIAN HEALTH SERVICE HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-823-2615
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:MCLAUGHLIN
Mailing Address - State:SD
Mailing Address - Zip Code:57642-0879
Mailing Address - Country:US
Mailing Address - Phone:605-823-4458
Mailing Address - Fax:605-823-2016
Practice Address - Street 1:701 EAST 6TH STREET
Practice Address - Street 2:
Practice Address - City:MCLAUGHLIN
Practice Address - State:SD
Practice Address - Zip Code:57642-0879
Practice Address - Country:US
Practice Address - Phone:605-823-4458
Practice Address - Fax:605-823-2016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND002331Medicaid
SD5540010Medicaid
ND1460889Medicaid