NPIMap

Organization Active NPI

Fort Thompson Indian Health Service

  • Clinic/Center
  • Fort Thompson, SD
National Provider Identifier
1710995907
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
FORT THOMPSON INDIAN HEALTH SERVICE
Practice address
Hwy 34 & 47
Fort Thompson, SD 57339-0200
Phone
(605) 245-1500
Fax
(605) 245-2384
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Madonna M Long
Title
Chief Executive Officer
Phone
(605) 245-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

Hwy 34 & 47
Fort Thompson, SD 57339-0200

Mailing address

Hwy 34 & 47
Fort Thompson, SD 57339-0200
Phone (605) 245-1500

Other identifiers 1

IdentifierTypeStateIssuer
5549010MedicaidSD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040120000889 TX Part B Supplier - Clinic/Group Practice 9739080896 Receives reassigned benefits from 8 practitioners
Practice locations: Fort Thompson, SD

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1710995907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HWY 34 & 47",
            "city": "FORT THOMPSON",
            "state": "SD",
            "postal_code": "573390200",
            "telephone_number": "605-245-1500",
            "fax_number": "605-245-2384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 34 & 47",
            "city": "FORT THOMPSON",
            "state": "SD",
            "postal_code": "573390200",
            "telephone_number": "605-245-1500",
            "fax_number": "605-245-2384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT THOMPSON INDIAN HEALTH SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "MADONNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "605-245-1500"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5549010",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Thompson, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.