Lower Brule Indian Health Service | |
601 Gall Street Lower Brule SD 57548-0248 | |
(605) 473-5526 | |
(605) 473-0828 |
Full Name | Lower Brule Indian Health Service |
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Speciality | Clinic/Center |
Location | 601 Gall Street, Lower Brule, South Dakota |
Authorized Official Name and Position | Eyvonne T Rekow (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 6054735526 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lower Brule Indian Health Service Po Box 248 601 Gall Street Lower Brule SD 57548-0248 Ph: (605) 473-5526 | Lower Brule Indian Health Service 601 Gall Street Lower Brule SD 57548-0248 Ph: (605) 473-5526 |
NPI Number | 1881719425 |
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Provider Enumeration Date | 03/20/2007 |
Last Update Date | 12/22/2016 |
Medicare PECOS PAC ID | 8224023585 |
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Medicare Enrollment ID | O20040423001291 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881719425 | NPI | - | NPPES |
4304882 | Other | SD | NABP |
5549020 | Medicaid | SD | |
HSZ133 | Other | SD | MEDICARE INDENTIFIER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (South Dakota) | Primary |
Provider Name | George J Ceremuga |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1760445613 PECOS PAC ID: 6204720824 Enrollment ID: I20041008000552 |
Provider Name | Leann K Batiz |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356684492 PECOS PAC ID: 0749429835 Enrollment ID: I20140903000475 |
Provider Name | Cassandra A Gutzmer |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1215285093 PECOS PAC ID: 4789835265 Enrollment ID: I20150220000814 |
Provider Name | Urooj Saeed |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1710272588 PECOS PAC ID: 2163732801 Enrollment ID: I20151109000254 |
Provider Name | Thuy-trang T Ngo |
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Provider Type | Practitioner - Nephrology |
Provider Identifiers | NPI Number: 1831327444 PECOS PAC ID: 5698990075 Enrollment ID: I20180109002084 |
Provider Name | Janell L Simpkins |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1619989605 PECOS PAC ID: 6204025661 Enrollment ID: I20180308000855 |
Provider Name | Seth A Mandel |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1255444022 PECOS PAC ID: 4688671209 Enrollment ID: I20190626002493 |
Provider Name | Alyssa Mae Welbig |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356851661 PECOS PAC ID: 5597025874 Enrollment ID: I20191028000022 |
Provider Name | Adam Peterson |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1033539937 PECOS PAC ID: 9436378734 Enrollment ID: I20200406003274 |
Provider Name | John D Nguyen |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1306078522 PECOS PAC ID: 8729116819 Enrollment ID: I20220427001157 |
Indian Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 Gall St, Lower Brule, SD 57548 Phone: 309-363-2711 |