Organization
OST CHR PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM M. WATTERS (OST CHR PROGRAM, DIRECTOR)
(605) 867-5801
Entity
Organization
Contact information
Practice address
102 WEST MAIN STREET, PINE RIDGE, SD 57770-0601
(605) 867-5801
(605) 867-5406
Mailing address
PO BOX 601, PINE RIDGE, SD 57770-0601
(605) 867-5801
(605) 867-5406
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PROVIDER#:9515380
—
SD
Enumeration date
03/17/2014
Last updated
03/17/2014
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