Provider Demographics
NPI:1710127501
Name:OGLALA SIOUX TRIBE HEALTH ADMINISTRATION
Entity Type:Organization
Organization Name:OGLALA SIOUX TRIBE HEALTH ADMINISTRATION
Other - Org Name:TRIBAL MANAGEMENT-THIRD PARTY BILLING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHRADER-DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:605-867-1704
Mailing Address - Street 1:P.O. BOX 5011
Mailing Address - Street 2:
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-5011
Mailing Address - Country:US
Mailing Address - Phone:605-867-1704
Mailing Address - Fax:605-867-2063
Practice Address - Street 1:200 AIRPORT ROAD - OLD DSS BUILDING
Practice Address - Street 2:EAST HIGHWAY - 18
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-5011
Practice Address - Country:US
Practice Address - Phone:605-867-1704
Practice Address - Fax:605-867-2063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OGLALA SIOUX TRIBE HEALTH ADMINISTRATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-06
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)