Healthcare Provider Details

I. General information

NPI: 1679587331
Provider Name (Legal Business Name): PINE POINT HEALTH STATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/07/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47520 MASHKIKI ST.
PONSFORD MN
56575
US

IV. Provider business mailing address

47520 MASHKIKI ST.
PONSFORD MN
56575
US

V. Phone/Fax

Practice location:
  • Phone: 218-573-2162
  • Fax: 218-573-3888
Mailing address:
  • Phone: 218-573-2162
  • Fax: 218-573-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN JACKSON
Title or Position: ADMINISTRATIVE OFFICER
Credential:
Phone: 218-983-4300