Healthcare Provider Details

I. General information

NPI: 1407760374
Provider Name (Legal Business Name): WHITE EARTH TRIBAL HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 310TH AVE
MAHNOMEN MN
56557-9393
US

IV. Provider business mailing address

2471 310TH AVE
MAHNOMEN MN
56557-9393
US

V. Phone/Fax

Practice location:
  • Phone: 218-935-2238
  • Fax: 218-572-4231
Mailing address:
  • Phone: 218-935-2238
  • Fax: 218-572-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRACY LHOTKA
Title or Position: CFO
Credential:
Phone: 218-983-4645