Oglala Sioux Tribe Continuum Of Care Center | |
1588 Us-18 Pine Ridge SD 57770 | |
(214) 738-8707 | |
(866) 781-9370 |
Full Name | Oglala Sioux Tribe Continuum Of Care Center |
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Speciality | Family Medicine |
Location | 1588 Us-18, Pine Ridge, South Dakota |
Authorized Official Name and Position | Kevin Killer (PRESIDENT) |
Authorized Official Contact | 6058648487 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Oglala Sioux Tribe Continuum Of Care Center 1588 Us-18 Pine Ridge SD 57770 Ph: (214) 738-8707 | Oglala Sioux Tribe Continuum Of Care Center 1588 Us-18 Pine Ridge SD 57770 Ph: (214) 738-8707 |
NPI Number | 1932824331 |
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Provider Enumeration Date | 10/07/2022 |
Last Update Date | 10/07/2022 |
Medicare PECOS PAC ID | 5991820599 |
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Medicare Enrollment ID | O20230117002029 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932824331 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Maryann Fanning |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225449226 PECOS PAC ID: 2163643198 Enrollment ID: I20190416001573 |
Provider Name | Cynthia Elaine Boltz |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083915789 PECOS PAC ID: 5395137376 Enrollment ID: I20220125001690 |
Provider Name | Kaleigh Krebs |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104478627 PECOS PAC ID: 5698005437 Enrollment ID: I20230222002270 |
Pine Ridge Indian Health Service Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: East Highway 18, Pine Ridge, SD 57701 Phone: 605-867-3032 | |
Pine Ridge Ihs Hospital Primary Care Clinic Medicare: Medicare Enrolled Practice Location: East Highway 18, Pine Ridge, SD 57770 Phone: 605-837-3314 Fax: 605-867-3332 |