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
1	3336C0003X	Community/Retail Pharmacy	2608565	MN
2	3336C0002X	Clinic Pharmacy	2608565	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1407887599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH SYSTEMS OF MOOSE LAKE INC

Provider Business Mailing Address
First Line	:	710 SOUTH 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	:	4570 COUNTY HWY 61
Second Line	:
City	:	MOOSE LAKE
State	:	MN
Zip	:	55767-9419
Country	:	US
Telephone Number	:	218-485-2111
Fax Number	:	218-485-8256

Authorized Official
Title or Position	:	COO
Name	:	MR. BILL STORCK
Credential	:
Telephone Number	:	217-485-5671

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/11/2025

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