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General NPI Number Information
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NPI Number | 1942932264
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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 | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 150 10TH ST NW
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City | MILACA
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State | MN
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Zip | 56353-1737
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Country | US
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Telephone | 320-532-3154
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX A
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City | ONAMIA
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State | MN
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Zip | 56359-0807
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM ROYCE NELSON
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Credential |
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Telephone | 320-532-2580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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