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General NPI Number Information
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NPI Number | 1306832894
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Entity Type | Organization
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Legal Business Name | SAWTOOTH MOUNTAIN CLINIC, INC.
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 513 5TH AVE W
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City | GRAND MARAIS
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State | MN
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Zip | 55604-3017
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Country | US
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Telephone | 218-387-2330
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Fax | 218-387-1278
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Provider Business Mailing Address
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Address Line | 513 5TH AVE W
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City | GRAND MARAIS
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State | MN
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Zip | 55604-3017
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Country | US
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Telephone | 218-387-2330
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Fax | 218-387-1278
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Authorized Official
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Title or Position | CFO
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Name | JEFF STODDARD
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Credential |
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Telephone | 218-877-8263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 22021
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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