Provider Demographics
NPI:1770712721
Name:YANKTON FEDERAL PRISON CAMP
Entity type:Organization
Organization Name:YANKTON FEDERAL PRISON CAMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-668-1138
Mailing Address - Street 1:1100 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3076
Practice Address - Country:US
Practice Address - Phone:605-665-3262
Practice Address - Fax:605-668-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health