Provider Demographics
NPI:1104060128
Name:OGLALA SIOUX TRIBE OTITIS MEDIA
Entity type:Organization
Organization Name:OGLALA SIOUX TRIBE OTITIS MEDIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL INSURANCE BILLER AND CODER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BLACK FEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-867-3004
Mailing Address - Street 1:18 EAST HIGHWAY IHS
Mailing Address - Street 2:PO BOX 1201
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-1201
Mailing Address - Country:US
Mailing Address - Phone:605-867-3004
Mailing Address - Fax:605-867-3374
Practice Address - Street 1:18 EAST HIGHWAY IHS
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-1201
Practice Address - Country:US
Practice Address - Phone:605-867-3004
Practice Address - Fax:605-867-3374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OGLALA SIOUX TRIBE OTITIS MEDIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD018A282NR1301X
SDR020891282NR1301X
SD4820282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural