# PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
- **Other names:** LaCreek District Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1003208257
- **Legal business name:** PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
- **Authorized official:** RHONDA M AKERS (HEALTH SYSTEM SPECIALIST)
- **Authorized official phone:** (605) 867-3032

## Contact information

- **Practice address:** 119 SOUTH 1ST AVENUE, MARTIN, SD 57551
- **Practice address phone:** (605) 685-2800
- **Mailing address:** 119 SOUTH 1ST AVENUE, MARTIN, SD 57551
- **Mailing address phone:** (605) 685-2800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |
| 261QP0904X | Federal Public Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/25/2015
- **Last updated:** 07/31/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 430098 | CCN | — |
| 05 | — | 5949000 | — | SD |