Provider Demographics
NPI:1962657338
Name:INDIANHEALTHSERVICES
Entity Type:Organization
Organization Name:INDIANHEALTHSERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POURIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-867-5131
Mailing Address - Street 1:EAST HWY 18
Mailing Address - Street 2:POST OFFICE BOX 1201
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-1201
Mailing Address - Country:US
Mailing Address - Phone:605-867-5131
Mailing Address - Fax:605-867-3262
Practice Address - Street 1:EAST HWY 18
Practice Address - Street 2:POST OFFICE BOX 1201
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-1201
Practice Address - Country:US
Practice Address - Phone:605-867-5131
Practice Address - Fax:605-867-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR035667261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care