Provider Demographics
NPI:1730854043
Name:OGLALA SIOUX TRIBE
Entity type:Organization
Organization Name:OGLALA SIOUX TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ZOE
Authorized Official - Last Name:CHARGEONHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-343-7832
Mailing Address - Street 1:PO BOX 9193
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709
Mailing Address - Country:US
Mailing Address - Phone:605-343-7832
Mailing Address - Fax:605-355-8808
Practice Address - Street 1:3200 CANYON LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-343-7832
Practice Address - Fax:605-355-8808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OGLALA SIOUX TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty