Provider Demographics
NPI:1932523644
Name:FT THOMPSON HEALTH CENTER
Entity Type:Organization
Organization Name:FT THOMPSON HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-245-1500
Mailing Address - Street 1:1323 BIA ROUTE 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:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service