NPIMap

Cheyenne River Sioux Tribe

Organization Active NPI Primary Care Clinic/Center · Laplante, SD

NPI 1104068428 · NPPES record last updated Aug 10, 2022

Key facts

NPI
1104068428
Entity type
Organization (NPI type 2)
Primary specialty
Primary Care Clinic/Center 261QP2300X
Legal business name
CHEYENNE RIVER SIOUX TRIBE
Practice address
15607 1St Ave
Laplante, SD 57652-0000
Phone
(605) 964-0772
Fax
(605) 964-1399
NPI assigned
Apr 1, 2009
Organization subpart
No

Authorized official

Name
Ramona Simon, RN
Title
Tribal Health Ceo
Phone
(605) 964-0785

Corporate family (same tax ID) 11

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Cheyenne River Sioux Tribe Behavorial Health (12 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Yes

Addresses

Primary practice location

15607 1St Ave
Laplante, SD 57652-0000

Mailing address

PO Box 590
Eagle Butte, SD 57625-0590
Phone (605) 964-6190

Other identifiers

IdentifierTypeStateIssuer
5549310MedicaidSD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 10, 2022.

{
    "created_epoch": "1238544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1104068428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 590",
            "city": "EAGLE BUTTE",
            "state": "SD",
            "postal_code": "576250590",
            "telephone_number": "605-964-6190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15607 1ST AVE",
            "city": "LAPLANTE",
            "state": "SD",
            "postal_code": "576520000",
            "telephone_number": "605-964-0772",
            "fax_number": "605-964-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEYENNE RIVER SIOUX TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-01",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "RAMONA",
        "authorized_official_title_or_position": "TRIBAL HEALTH CEO",
        "authorized_official_telephone_number": "605-964-0785",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5549310",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.