Healthcare Provider Details

I. General information

NPI: 1598911893
Provider Name (Legal Business Name): WHITE EARTH HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40520 COUNTY HIGHWAY 34
OGEMA MN
56569-9612
US

IV. Provider business mailing address

40520 COUNTY HIGHWAY 34
OGEMA MN
56569-9612
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-4300
  • Fax: 218-983-6217
Mailing address:
  • Phone: 218-983-4300
  • Fax: 218-983-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LEEANN MARIE THORSON
Title or Position: ACTING DEPUTY CEO
Credential:
Phone: 218-983-6303