WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER (SISSE-WHAPETON OYATE HEALTH CARE CENTER AND SISSETON INDIAN HEALTH SER) - NPI NUMBER 1366471666

Summary

Provider Name: WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER (SISSE-WHAPETON OYATE HEALTH CARE CENTER AND SISSETON INDIAN HEALTH SER)

NPI Number: 1366471666

Clasification: Clinic/Center (261Q00000X)

Address:
100 LAKE TRAVERSE DRIVE
SISSETON, SD
ZIP 57262

Phone Number: (605) 698-7606



Detailed Information

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER is a clinic/center in Sisseton, SD. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). The assigned NPI number for this provider is 1366471666 and is registered as an organization entity type.
The provider Other Name Is Sisse-whapeton Oyate Health Care Center And Sisseton Indian Health Ser.

The provider's business address is:

100 LAKE TRAVERSE DRIVE
SISSETON, SD
ZIP 57262
Phone: (605) 698-7606
Fax: (605) 742-3882

The provider's authorized official is Richard D Huff .
The authorized official title is Ceo and has the following contact phone number (605) 698-7606.

The enumeration date for this NPI number is 7/1/2006 and was last updated on 10/7/2009.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261Q00000X Clinic/Center Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 430085 MEDICARE PIN
2 HS2177 MEDICARE PIN
3 5549030 MEDICAID SD

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1366471666 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name SISSE-WHAPETON OYATE HEALTH CARE CENTER AND SISSETON INDIAN HEALTH SER Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 5 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 100 LAKE TRAVERSE DRIVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name SISSETON The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name SD The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 57262 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 6056987606 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 6057423882 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 7/1/2006 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 10/7/2009 The date that a record was last updated or changed.
16 Authorized Official Last Name HUFF The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name RICHARD The first name of the authorized official.
18 Authorized Official Middle Name D The middle name of the authorized official.
19 Authorized Official Title or Position CEO The title or position of the authorized official.
20 Authorized Official Telephone Number 6056987606 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 261Q00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 430085 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 1 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier 2 HS2177 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier 3 5549030 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 3 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier State 3 SD
30 Is Organization Subpart N
31 Authorized Official Name Prefix Text MR.

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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