Provider Demographics
NPI:1033313879
Name:INDIAN HEALTH SERVICE
Entity type:Organization
Organization Name:INDIAN HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIAGNOSTIC SONOGRAPHER RADIOGRAPHER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELKUS
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RT,R, CT
Authorized Official - Phone:406-477-4493
Mailing Address - Street 1:100 CHEYENNE
Mailing Address - Street 2:
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 BLUE SAGE CT
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-2257
Practice Address - Country:US
Practice Address - Phone:406-477-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1089362471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty