Fort Yates Indian Health Service Hospital

Primary specialty

Federal Public Health Clinic/CenterTaxonomy code 261QP0904X

Legal business name

FORT YATES INDIAN HEALTH SERVICE HOSPITAL

Doing business as

Cannonball Clinic

Practice address

6998 Weasel Street
Cannonball, ND 58528

Phone

(701) 854-3831

Fax

(701) 854-7411

NPI assigned

Feb 1, 2007

Last updated

Aug 9, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

FORT YATES INDIAN HEALTH SERVICE HOSPITALAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jana Rhea Gipp

Title

Chief Executive Officer

Phone

(701) 854-8211

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CANNONBALL CLINIC Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Fort Yates Indian Health Service Hospital

  • Critical Access Hospital
  • Fort Yates, ND
  • NPI 1609851039

  O20040315001479

  Same enrollment

Part of

Fort Yates IHS Hospital

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Fort Yates Indian Health Service Hospital

  • Health Service Clinic/Center
  • Bullhead, SD
  • NPI 1497347579

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1336286798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX J",
            "city": "FORT YATES",
            "state": "ND",
            "postal_code": "585380527",
            "telephone_number": "701-854-3831",
            "fax_number": "701-854-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6998 WEASEL STREET",
            "city": "CANNONBALL",
            "state": "ND",
            "postal_code": "58528",
            "telephone_number": "701-854-3831",
            "fax_number": "701-854-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT YATES INDIAN HEALTH SERVICE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORT YATES INDIAN HEALTH SERVICE HOSPITAL",
        "enumeration_date": "2007-02-01",
        "last_updated": "2018-08-09",
        "status": "A",
        "authorized_official_last_name": "GIPP",
        "authorized_official_first_name": "JANA",
        "authorized_official_middle_name": "RHEA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "701-854-8211"
    },
    "taxonomies": [
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1459056",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CANNONBALL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CANNONBALL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Precious Elsie Cottonwood
• Santana Rose Hettich, CMA 2
• Kevin James Lewis
• Londa Lenae Pedersen, M.S
• Alisa Thunder Hawk
• Lois Two Bears

• Clinic/Center in Cannon Ball, ND
• Providers in Cannon Ball, ND by specialty
• Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.