NPIMap

Organization Active NPI

Sisseton Wahpeton Oyate of the Lake Traverse Reservation

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Sisseton, SD
National Provider Identifier
1386464402
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION
Practice address
114 Lake Traverse Dr Ste 102
Sisseton, SD 57262-7046
Phone
(833) 674-3444
NPI assigned
Oct 14, 2024
Last updated
Oct 14, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Authorized official

Name
Elise Johnson
Title
Tribal Health Director
Phone
(605) 698-3911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X Primary

Addresses

Primary practice location

114 Lake Traverse Dr Ste 102
Sisseton, SD 57262-7046

Mailing address

PO Box 509
Sisseton, SD 57262-0509
Phone (605) 742-3697

Other names 1

  • Asniyapi Field Mobile Unit Other name

National Provider Directory

National Provider Directory
Tax ID family
Sisseton Wahpeton Oyate of the Lake Traverse Reservation7 organizations share this tax ID, including this one
Part of
Sisseton Wahpeton Oyate of the Lake Traverse Reservation

Other organizations with this tax ID 6

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

Locations

114 Lake Traverse Dr
Ste 102
Sisseton, SD 57262
Phone (833) 674-3444

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1728864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1386464402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 509",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "572620509",
            "telephone_number": "605-742-3697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 LAKE TRAVERSE DR STE 102",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "572627046",
            "telephone_number": "833-674-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION",
        "enumeration_date": "2024-10-14",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ELISE",
        "authorized_official_title_or_position": "TRIBAL HEALTH DIRECTOR",
        "authorized_official_telephone_number": "605-698-3911"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Asniyapi Field Mobile Unit",
            "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 Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.