Bois Forte Reservation Tribal Government | |
5219 St. John Dr Nett Lake MN 55772 | |
(218) 757-3650 | |
Not Available |
Full Name | Bois Forte Reservation Tribal Government |
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Speciality | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
Location | 5219 St. John Dr, Nett Lake, Minnesota |
Authorized Official Name and Position | Catherine Chavers (TRIBAL CHAIRMAN) |
Authorized Official Contact | 2187573361 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Bois Forte Reservation Tribal Government 5219 Saint John Dr Orr MN 55771-8232 Ph: (218) 757-3650 | Bois Forte Reservation Tribal Government 5219 St. John Dr Nett Lake MN 55772 Ph: (218) 757-3650 |
NPI Number | 1073530150 |
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Provider Enumeration Date | 07/16/2006 |
Last Update Date | 05/19/2022 |
Medicare PECOS PAC ID | 7517879778 |
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Medicare Enrollment ID | O20031105000284 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073530150 | NPI | - | NPPES |
177515400 | Medicaid | MN | |
63G35BO | Other | MN | BCBS |
Provider Name | Wendy S Long |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689873598 PECOS PAC ID: 4385731538 Enrollment ID: I20071105000099 |
Provider Name | William J Durie |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1528096195 PECOS PAC ID: 6406982008 Enrollment ID: I20100408000210 |
Provider Name | Crystal L Lobe |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1174834709 PECOS PAC ID: 0941494066 Enrollment ID: I20101103000320 |
Provider Name | Kevin J Schulte |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1194816967 PECOS PAC ID: 1355536780 Enrollment ID: I20101111000666 |
Provider Name | Shanna Rachelle Vidor |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1215229729 PECOS PAC ID: 9830349380 Enrollment ID: I20121018000799 |
Provider Name | Paul Steven Rasmussen |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285153007 PECOS PAC ID: 9032485131 Enrollment ID: I20171017002710 |
Provider Name | Brandon Mark Anderson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225536592 PECOS PAC ID: 2466870639 Enrollment ID: I20200921001386 |
Bois Forte Human Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13071 Nett Lake Road, Suite B, Nett Lake, MN 55772 Phone: 218-757-3295 Fax: 218-757-0234 |