| Organization Name: | WHITE EARTH BAND OF CHIPPEWA |
| NPI Number: | 1396848560 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIM J HOGLUND (BILLING MANAGER) |
| Mailing Address: | 25519 State Highway 224 Ogema |
| State: | MN US |
| Postal Code: | 565699506 |
| Phone Number: | 2189834300 |
| Fax Number: | |
| NPI Enumeration Date: | 09/06/2006 |
| NPI Last Update Date: | 01/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |