# TRIBAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578790986
- **Authorized official:** ELIZABETH A SHORTMAN CHS (MANAGED CARE/CHS SUPERVISOR)
- **Authorized official phone:** (605) 997-2642

## Contact information

- **Practice address:** 701 W BROAD AVE, FLANDREAU, SD 57028-1529
- **Practice address phone:** (605) 997-3844
- **Practice address fax:** (605) 997-3694
- **Mailing address:** 701 W BROAD AVE, FLANDREAU, SD 57028-1529
- **Mailing address phone:** (605) 997-3844
- **Mailing address fax:** (605) 997-3694

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | LPC-MH2183 | SD | Yes |

## Other

- **Enumeration date:** 06/12/2009
- **Last updated:** 06/12/2009