Basic Information
| Provider Information | |||||||||
| NPI: | 1255575536 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SISSETON WAHPETON OYATE HEALTH CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 LAKE TRAVERSE DR | ||||||||
| Address2: | |||||||||
| City: | SISSETON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572627046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057423633 | ||||||||
| FaxNumber: | 6056983141 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 LAKE TRAVERSE DR | ||||||||
| Address2: | |||||||||
| City: | SISSETON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572627046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057423633 | ||||||||
| FaxNumber: | 6056983141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 04/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | OPSAL | ||||||||
| AuthorizedOfficialFirstName: | GERALDINE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL TECHNICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6057423633 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.