Organization
CRST COMMUNITY HEALTH REPRESENTATIVES (CHR) PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RAMONA SIMON (TRIBAL HEALTH CEO)
(605) 964-0785
Entity
Organization
Contact information
Practice address
24276 166TH ST, EAGLE BUTTE, SD 57625-8141
(605) 964-0728
(605) 964-0734
Mailing address
P.O. BOX 590, 24276 AIRPORT RD,, EAGLE BUTTE, SD 57625-0590
(605) 964-0728
(605) 964-0734
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5546290
—
SD
Enumeration date
08/26/2020
Last updated
08/05/2022
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