Healthcare Provider Details

I. General information

NPI: 1164920963
Provider Name (Legal Business Name): NACC TRIBAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 E FRANKLIN AVE
MINNEAPOLIS MN
55404-2923
US

IV. Provider business mailing address

1213 E FRANKLIN AVE
MINNEAPOLIS MN
55404-2923
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-8086
  • Fax: 612-872-8547
Mailing address:
  • Phone: 612-872-8086
  • Fax: 612-872-8547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAM STRONG
Title or Position: ECONOMIC DEVELOPMENT DIRECTOR
Credential:
Phone: 218-679-3341