MEDICARE: SPIRIT LAKE HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center		ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073665493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRIT LAKE HEALTH CENTER

Provider Business Mailing Address
First Line	:	3883 74TH AVE NE
Second Line	:	PO BOX 309
City	:	FORT TOTTEN
State	:	ND
Zip	:	58335-0309
Country	:	US
Telephone Number	:	701-766-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3883 74TH AVE NE
Second Line	:
City	:	FORT TOTTEN
State	:	ND
Zip	:	58335-0309
Country	:	US
Telephone Number	:	701-766-1600
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARLENE M KRULISH
Credential	:
Telephone Number	:	701-766-1600

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/21/2022

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Directions to “SPIRIT LAKE HEALTH CENTER ” Practice Location

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