Organization
FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Active
Parent organization
FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Other names
CANNONBALL CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Authorized official
JANA RHEA GIPP (CHIEF EXECUTIVE OFFICER)
(701) 854-8211
Entity
Organization
Contact information
Practice address
6998 WEASEL STREET, CANNONBALL, ND 58528
(701) 854-3831
(701) 854-7411
Mailing address
PO BOX J, FORT YATES, ND 58538-0527
(701) 854-3831
(701) 854-7411
Taxonomy
Speciality
Code
Description
License number
State
261QP0904X
Federal Public Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1459056
—
ND
Enumeration date
02/01/2007
Last updated
08/09/2018
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