Provider Demographics
NPI:1841418621
Name:INDIAN HEALTH SERVICES
Entity Type:Organization
Organization Name:INDIAN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-964-3007
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:RIDGEVIEW
Mailing Address - State:SD
Mailing Address - Zip Code:57652-0241
Mailing Address - Country:US
Mailing Address - Phone:605-733-2443
Mailing Address - Fax:
Practice Address - Street 1:IHS MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625
Practice Address - Country:US
Practice Address - Phone:605-964-3007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR035042313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility