| Organization Name: | CHEYENNE RIVER SIOUX TRIBE DIABETES CLINIC |
| NPI Number: | 1265856561 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DELEEN KOUGL (TRIBAL HEALTH CEO) |
| Mailing Address: | 24276 166th Street Airport Road Eagle Butte |
| State: | SD US |
| Postal Code: | 576250590 |
| Phone Number: | 6059640788 |
| Fax Number: | 6059641062 |
| NPI Enumeration Date: | 02/07/2014 |
| NPI Last Update Date: | 02/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |