Organization
TRIBAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH A SHORTMAN CHS (MANAGED CARE/CHS SUPERVISOR)
(605) 997-2642
Entity
Organization
Contact information
Practice address
701 W BROAD AVE, FLANDREAU, SD 57028-1529
(605) 997-3844
(605) 997-3694
Mailing address
701 W BROAD AVE, FLANDREAU, SD 57028-1529
(605) 997-3844
(605) 997-3694
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
LPC-MH2183
SD
Other
Enumeration date
06/12/2009
Last updated
06/12/2009
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