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

Similar Providers

NPI Provider Name / Taxonomy
1588978589 COTEAU DES PRAIRIES HOSPITAL
Clinic/Center
1649417072 SISSETON WAHPETON HEALTH CARE CENTER
Clinic/Center
1972615995 LEAH M THIELEN
Clinic/Center
1144470824 US DEPT OF HEALTH & HUMAN SERVICES
Clinic/Center (Public Health, Federal)
1174569669 PRAIRIE LAKES HEALTHCARE SYSTEM INC.
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1437558822 PAULA BOSSERT
Clinic/Center (Mental Health (Including Community Mental Health Center))
1659410009 COTEAU DES PRAIRIES HOSPITAL
Clinic/Center (Multi-Specialty)

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
1 NPI 1366471666
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER
5 Provider Other Organization Name SISSE-WHAPETON OYATE HEALTH CARE CENTER AND SISSETON INDIAN HEALTH SER
6 Provider Other Organization Name Type Code 5
7 Provider First Line Business Practice Location Address 100 LAKE TRAVERSE DRIVE
8 Provider Business Practice Location Address City Name SISSETON
9 Provider Business Practice Location Address State Name SD
10 Provider Business Practice Location Address Postal Code 57262
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 6056987606
13 Provider Business Practice Location Address Fax Number 6057423882
14 Provider Enumeration Date 7/1/2006
15 Last Update Date 10/7/2009
16 Authorized Official Last Name HUFF
17 Authorized Official First Name RICHARD
18 Authorized Official Middle Name D
19 Authorized Official Title or Position CEO
20 Authorized Official Telephone Number 6056987606
21 Healthcare Provider Taxonomy Code 1 261Q00000X
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 430085
24 Other Provider Identifier Type Code 1 08
25 Other Provider Identifier 2 HS2177
26 Other Provider Identifier Type Code 2 08
27 Other Provider Identifier 3 5549030
28 Other Provider Identifier Type Code 3 05
29 Other Provider Identifier State 3 SD
30 Is Organization Subpart N
31 Authorized Official Name Prefix Text MR.

Download Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.