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General NPI Number Information
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NPI Number | 1326200411
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Entity Type | Organization
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Legal Business Name | MILLE LACS HEALTH SYSTEM
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 26362 370TH AVE
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City | HILLMAN
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State | MN
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Zip | 56338-2349
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Country | US
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Telephone | 320-277-3682
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Fax | 320-277-3372
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Provider Business Mailing Address
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Address Line | 200 ELM ST N PO BOX A
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City | ONAMIA
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State | MN
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Zip | 56359-7901
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Country | US
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Telephone | 320-532-3154
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Fax | 320-532-3111
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Authorized Official
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Title or Position | CFO
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Name | MR. JOHN W UNZEN
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Credential |
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Telephone | 320-532-2581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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