NPIMap

Organization Active NPI

Woodrow Wilson Keeble Memorial Health Care Center

  • Clinic/Center
  • Sisseton, SD
National Provider Identifier
1366471666
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER
Practice address
100 Lake Traverse Drive
Sisseton, SD 57262
Phone
(605) 698-7606
Fax
(605) 742-3882
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Ms. Juanita Gott
Title
Ceo
Phone
(605) 698-7606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

100 Lake Traverse Drive
Sisseton, SD 57262

Mailing address

100 Lake Traverse Drive
Sisseton, SD 57262
Phone (605) 698-7606

Other identifiers 1

IdentifierTypeStateIssuer
5549030MedicaidSD

Other names 1

  • Sisse-Whapeton Oyate health Care Center and Sisseton Indian Health Ser Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031120000810 TX Part B Supplier - Clinic/Group Practice 1850295940 Receives reassigned benefits from 52 practitioners
Practice locations: Sisseton, SD

National Provider Directory

National Provider Directory

Locations

100 Lake Traverse Dr
Sisseton, SD 57262

Practitioners & affiliated clinicians

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1366471666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 LAKE TRAVERSE DRIVE",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "57262",
            "telephone_number": "605-698-7606",
            "fax_number": "605-742-3882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LAKE TRAVERSE DRIVE",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "57262",
            "telephone_number": "605-698-7606",
            "fax_number": "605-742-3882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "GOTT",
        "authorized_official_first_name": "JUANITA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-698-7606",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5549030",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sisse-Whapeton Oyate health Care Center and Sisseton Indian Health Ser",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Sisse-Whapeton Oyate health Care Center and Sisseton Indian Health Ser",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sisseton, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; 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.