Organization
PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Active
Parent organization
PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Other names
LaCreek District Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Authorized official
RHONDA M AKERS (HEALTH SYSTEM SPECIALIST)
(605) 867-3032
Entity
Organization
Contact information
Practice address
119 SOUTH 1ST AVENUE, MARTIN, SD 57551
(605) 685-2800
Mailing address
119 SOUTH 1ST AVENUE, MARTIN, SD 57551
(605) 685-2800
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QP0904X
Federal Public Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430098
CCN
—
05
—
5949000
—
SD
Enumeration date
02/25/2015
Last updated
07/31/2020
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