Provider Demographics
NPI:1194757369
Name:ROSEBUD INDIAN HEALTH SERVICE
Entity type:Organization
Organization Name:ROSEBUD INDIAN HEALTH SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-747-2231
Mailing Address - Street 1:400 SOLDIER CREEK ROAD
Mailing Address - Street 2:PO BOX 400
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0400
Mailing Address - Country:US
Mailing Address - Phone:605-747-2231
Mailing Address - Fax:605-747-2216
Practice Address - Street 1:400 SOLDIER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0400
Practice Address - Country:US
Practice Address - Phone:605-747-3245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0140080Medicaid
SD5549520Medicaid
SD5549093Medicaid
SD5540080Medicaid
SDPHS000Medicare UPIN
SD0140080Medicaid
430084Medicare Oscar/Certification
HSZ033Medicare PIN
SD430084Medicare Oscar/Certification
SD5549093Medicaid