Healthcare Provider Details

I. General information

NPI: 1326425943
Provider Name (Legal Business Name): TURTLE MOUNTAIN BAND OF CHIPPEWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 CHIEF LITTLE SHELL STREET NE
BELCOURT ND
58316
US

IV. Provider business mailing address

PO BOX 900
BELCOURT ND
58316-0900
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-5696
  • Fax:
Mailing address:
  • Phone: 701-477-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. BLAINE MALATERRE
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-477-5696