Organization Name: | MILLE LACS BAND OF OJIBWE INDIANS |
NPI Number: | 1831385509 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SAMUEL MOOSE (COMMISSIONER OF HEALTH & HUMAN SERV) |
Mailing Address: | 45741 Grace Lake Road Sandstone |
State: | MN US |
Postal Code: | 550723203 |
Phone Number: | 3203840149 |
Fax Number: | 3203840916 |
NPI Enumeration Date: | 09/17/2007 |
NPI Last Update Date: | 03/23/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |