Healthcare Provider Details

I. General information

NPI: 1548212699
Provider Name (Legal Business Name): MILLE LACS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ELM ST N
ONAMIA MN
56359-7901
US

IV. Provider business mailing address

200 ELM ST N PO BOX A
ONAMIA MN
56359-7901
US

V. Phone/Fax

Practice location:
  • Phone: 320-532-3154
  • Fax: 320-532-3111
Mailing address:
  • Phone: 320-532-3154
  • Fax: 320-532-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number201047-0
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number343531
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number331503
License Number StateMN

VIII. Authorized Official

Name: MR. JOHN W UNZEN
Title or Position: CFO
Credential:
Phone: 320-532-2581