| Organization Name: | SPIRIT LAKE HEALTH CENTER |
| NPI Number: | 1134303795 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | COLETTTE A BYRUM (MEDICAL INSTRUMENT TECHNOLOGIST) |
| Mailing Address: | 3883 74th Ave Ne Fort Totten |
| State: | ND US |
| Postal Code: | 583350309 |
| Phone Number: | 7017661600 |
| Fax Number: | |
| NPI Enumeration Date: | 12/19/2007 |
| NPI Last Update Date: | 12/19/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0206X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology, Mammography |
| Taxonomy Definition: | |