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NPI Code Detail

MEDICARE: FAMILY HEALTH SYSTEMS OF MOOSE LAKE INC

MEDICARE: FAMILY HEALTH SYSTEMS OF MOOSE LAKE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy2614902MN
23336C0002XClinic Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073544151
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY HEALTH SYSTEMS OF MOOSE LAKE INC
Provider Business Mailing Address
First Line : 710 S KENWOOD AVE
Second Line :
City : MOOSE LAKE
State : MN
Zip : 55767
Country : US
Telephone Number : 218-485-5671
Fax Number :
Provider Business Practice Location Address
First Line : 204 LUNDORFF DR
Second Line :
City : SANDSTONE
State : MN
Zip : 55072-5051
Country : US
Telephone Number : 320-245-5500
Fax Number : 320-245-5123
Authorized Official
Title or Position : COO
Name : MR. BILL STORCK
Credential :
Telephone Number : 218-485-5671
Provider Enumeration Date : 07/06/2006
Last Update Date : 09/11/2025

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