Organization Name: | CHEYENNE RIVER SIOUX TRIBE FIELD HEALTH CLINIC |
NPI Number: | 1457593725 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DELEEN KOUGL (TRIBAL HEALTH CEO) |
Mailing Address: | 314 Main St. Eagle Butte |
State: | SD US |
Postal Code: | 57625 |
Phone Number: | 6059648919 |
Fax Number: | 6059641399 |
NPI Enumeration Date: | 04/01/2009 |
NPI Last Update Date: | 06/27/2011 |
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: |