Healthcare Provider Details

I. General information

NPI: 1144016957
Provider Name (Legal Business Name): BOIS FORTE RESERVATION TRIBAL COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CHESTNUT ST
VIRGINIA MN
55792-2523
US

IV. Provider business mailing address

5219 SAINT JOHN DR
ORR MN
55771-8232
US

V. Phone/Fax

Practice location:
  • Phone: 218-757-3650
  • Fax:
Mailing address:
  • Phone: 218-757-3650
  • Fax: 218-757-0204

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: CHRISTIE SWANSON
Title or Position: PRC AND BILLING SPECIALIST
Credential:
Phone: 218-757-3650