MEDICARE: MILLE LACS HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363AM0700X	Medical Physician Assistant
3	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	115808	OTHER	MN	UCARE MINNESOTA
2	33523MI	OTHER	MN	BLUE CROSS BLUE SHIELD MINNESOTA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326200411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLE LACS HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	200 ELM ST N
Second Line	:	PO BOX A
City	:	ONAMIA
State	:	MN
Zip	:	56359-7901
Country	:	US
Telephone Number	:	320-532-3154
Fax Number	:	320-532-3111

Provider Business Practice Location Address
First Line	:	26362 370TH AVE
Second Line	:
City	:	HILLMAN
State	:	MN
Zip	:	56338-2349
Country	:	US
Telephone Number	:	320-277-3682
Fax Number	:	320-277-3372

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOHN W UNZEN
Credential	:
Telephone Number	:	320-532-2581

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	04/26/2017

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Directions to “MILLE LACS HEALTH SYSTEM ” Practice Location

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