MEDICARE: WHITE EARTH INDIAN HEALTH CENTER

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
1	261QP0904X	Federal Public Health Clinic/Center

General Provider Information

NPI Number	:	1093761710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE EARTH INDIAN HEALTH CENTER

Provider Business Mailing Address
First Line	:	40520 COUNTY HIGHWAY 34
Second Line	:
City	:	OGEMA
State	:	MN
Zip	:	56569-9612
Country	:	US
Telephone Number	:	218-983-4300
Fax Number	:	218-983-6394

Provider Business Practice Location Address
First Line	:	40520 COUNTY HIGHWAY 34
Second Line	:
City	:	OGEMA
State	:	MN
Zip	:	56569-9612
Country	:	US
Telephone Number	:	218-983-4300
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE OFFICER
Name	:	JOCELYN JACKSON
Credential	:
Telephone Number	:	218-983-4300

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	06/30/2023

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Directions to “WHITE EARTH INDIAN HEALTH CENTER ” Practice Location

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