Full Name | |
---|---|
Speciality | Clinic/center - Public Health, Federal |
Location | 2471 310th Ave, Mahnomen, Minnesota |
Authorized Official Name and Position | Jocelyn Jackson (ADMINISTRATIVE OFFICER) |
Authorized Official Contact | 2189834300 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 190 Naytahwaush MN 56566-0190 Ph: (218) 935-2238 | 2471 310th Ave Mahnomen MN 56557 Ph: (218) 935-2238 |
NPI Number | 1740202308 |
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Provider Enumeration Date | 07/24/2006 |
Last Update Date | 07/17/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740202308 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP0904X | Clinic/center - Public Health, Federal | (* (Not Available)) | Primary |