Healthcare Provider Details

I. General information

NPI: 1487797544
Provider Name (Legal Business Name): NORTHERN ITASCA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 PINE TREE DRIVE
BIGFORK MN
56628-0258
US

IV. Provider business mailing address

PO BOX 258 258 PINE TREE DRIVE
BIGFORK MN
56628-0258
US

V. Phone/Fax

Practice location:
  • Phone: 218-743-4444
  • Fax: 218-743-4232
Mailing address:
  • Phone: 218-743-4444
  • Fax: 218-743-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number261348
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number261348
License Number StateMN

VIII. Authorized Official

Name: DR. HEATHER LEIGH BIBEAU
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 218-743-4444