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1195 County Road 77 Tower MN 55790 | |
(218) 757-0111 | |
(218) 757-0109 |
Full Name | |
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Speciality | Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy |
Location | 1195 County Road 77, Tower, Minnesota |
Authorized Official Name and Position | Lynette Tahtinen (DATA & FINANCE SPECIALIST) |
Authorized Official Contact | 2187573295 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5219 St John Drive Nett Lake MN 55772-8232 Ph: (218) 757-3295 | 1195 County Road 77 Tower MN 55790 Ph: (218) 757-0111 |
NPI Number | 1538371117 |
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Provider Enumeration Date | 05/04/2007 |
Last Update Date | 05/15/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538371117 | NPI | - | NPPES |
036862800 | Other | MN | 101YA0400X |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
332800000X | Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy | (* (Not Available)) | Primary |