Provider Demographics
NPI:1720402498
Name:FT THOMPSON IHS HEALTH CENTER
Entity Type:Organization
Organization Name:FT THOMPSON IHS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-245-1522
Mailing Address - Street 1:1323 BIA RTE 4
Mailing Address - Street 2:
Mailing Address - City:FT THOMPSON
Mailing Address - State:SD
Mailing Address - Zip Code:57339
Mailing Address - Country:US
Mailing Address - Phone:605-245-1500
Mailing Address - Fax:605-245-2600
Practice Address - Street 1:1323 BIA RTE 4
Practice Address - Street 2:
Practice Address - City:FT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339
Practice Address - Country:US
Practice Address - Phone:605-245-1500
Practice Address - Fax:605-245-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal