Basic Information
| Provider Information | |||||||||
| NPI: | 1548392095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANSLAW | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | BEHAVIORAL HEALTH DEPT./ INDIAN HEALTH SERVICE | ||||||||
| Address2: | PINE RIDGE HOSPITAL/ EAST HWY 18/ PO BOX 1201 | ||||||||
| City: | PINE RIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577701201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058673100 | ||||||||
| FaxNumber: | 6058673274 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 EAST HWY 18 / PINE RIDGE HOSPITAL | ||||||||
| Address2: | BEHAVIORAL HEALTH DEPT./ INDIAN HEALTH SERVICE | ||||||||
| City: | PINE RIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577701201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058673100 | ||||||||
| FaxNumber: | 6058673274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2007 | ||||||||
| LastUpdateDate: | 04/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 42587 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 256385-1 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.