Organization
PINE RIDGE INDIAN HEALTH SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUANE ROBERT ROSS (ADMINISTRATIVE OFFICER)
(605) 867-3040
Entity
Organization
Contact information
Practice address
EAST HIGHWAY 18, PINE RIDGE, SD 57701
(605) 867-3032
Mailing address
PO BOX 1201, PINE RIDGE, SD 57770-1201
(605) 867-3032
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HSZ153
MEDICARE PART B
—
Enumeration date
11/13/2017
Last updated
11/13/2017
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