Cherry Creek Tribal Health Center
Organization Active NPI Primary Care Clinic/Center · Cherry Creek, SD
NPI 1295977510 · NPPES record last updated Aug 10, 2022
Key facts
- NPI
- 1295977510
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- CHERRY CREEK TRIBAL HEALTH CENTER
- Practice address
- 11 5TH Ave
Cherry Creek, SD 57622 - Phone
- (605) 964-6190
- 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
National Provider Directory
- Tax ID family
- Cheyenne River Sioux Tribe Behavorial Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | SD | Yes |
Addresses
Primary practice location
11 5TH Ave
Cherry Creek, SD 57622
Mailing address
PO Box 590
Eagle Butte, SD 57625-0590
Phone (605) 964-0772
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5549320 | Medicaid | SD |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.