Provider Demographics
NPI:1952646523
Name:ROSEBUD IHS HOSPITAL
Entity Type:Organization
Organization Name:ROSEBUD IHS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-747-2231
Mailing Address - Street 1:26045 U.S. HWY 18
Mailing Address - Street 2:901 WEST B.I.A RT. 1
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0400
Mailing Address - Country:US
Mailing Address - Phone:605-747-2231
Mailing Address - Fax:605-747-2216
Practice Address - Street 1:BIA SOLDIER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0400
Practice Address - Country:US
Practice Address - Phone:605-747-2231
Practice Address - Fax:605-747-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR041141313M00000X
SDR039288313M00000X
MNR202324-7313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR202324-7OtherCLINICAL NURSE
SDR041141OtherCLINICAL NURSE
SDR039288OtherCLINICAL NURSE
CAR039788OtherCLINICAL NURSE