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White Earth Band of Chippewa

Organization Active NPI Land Ambulance · White Earth, MN

NPI 1033129556 · NPPES record last updated Jan 7, 2008

Key facts

NPI
1033129556
Entity type
Organization (NPI type 2)
Primary specialty
Land Ambulance 3416L0300X
License
0354 (MN)
Legal business name
WHITE EARTH BAND OF CHIPPEWA
Practice address
26246 Crane Rd
White Earth, MN 56591-9998
Phone
(218) 983-3285
Fax
(218) 983-4299
NPI assigned
Aug 8, 2006
Organization subpart
No

Authorized official

Name
Kim Hoglund
Title
Billing Manager
Phone
(218) 936-5586

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 25

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

  • Willy Ann Heisler, S.W. Student in an Organized Health Care Education/Training Program · White Earth, MN · NPI 1578571410
    NPD (past)

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
White Earth Home Health Agency
White Earth, MN · CCN 247096		 Home health agency 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2010

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070907000265 TX Part B Supplier - Ambulance Service Supplier 7315993995 Practice locations: Ogema, MN

National Provider Directory

Tax ID family
White Earth Oshki Manidoo New Spirit Center (26 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 0354 MN Yes

Addresses

Primary practice location

26246 Crane Rd
White Earth, MN 56591-9998

Mailing address

PO Box 328
White Earth, MN 56591-0328
Phone (218) 983-3285

Other identifiers

IdentifierTypeStateIssuer
8183263OtherMNMEDICA
56M66WHOtherMNBLUE CROSS BLUE SHIELD

Other names

  • White Earth Reservation Ambulance Service Other name

Other providers in White Earth, MN

All providers in White Earth, MN · Land Ambulance in Minnesota

Sources for this page

Verify at the official NPI Registry.