Spirit Lake Tribe
Organization Active NPI Health Service Clinic/Center · Fort Totten, ND
NPI 1114472891 · NPPES record last updated Apr 7, 2020
Key facts
- NPI
- 1114472891
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Service Clinic/Center 261QH0100X
- Legal business name
- SPIRIT LAKE TRIBE
- Practice address
- 3883 74TH Ave NE
Fort Totten, ND 58335 - Phone
- (701) 766-1600
- Fax
- (701) 766-1630
- NPI assigned
- Aug 23, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- SPIRIT LAKE TRIBE
Authorized official
- Name
- Arlene Krulish
- Title
- Ceo
- Phone
- (701) 766-1607
Other NPIs with the same Medicare PAC ID 1
Practitioners 77
-
Helen Marie Early, FNP
-
Nevin Gillis, MD
-
Deborah L Hanson, LICSW
-
Cheryl A. Hefta, NP
-
Kaylee Heisler, PT
-
Katie Jo Jorgenson, LAC, LMSW
-
Nikki Lafromboise, LCSW
-
Sheila Marie Lindgren, PA-C
-
Macie Mikkelsen, FNP-C
-
Stella Onyeakazi, FNP-BC
-
Ashley Pederson, DPT
-
Steven L Pederson, DPT
-
Zachary Tomas Smith, D.C.
-
Melissa Thomas, FNP-BC
-
Andrea M Macfadden, APN, BC
-
John Carlyle Miller, DPM
-
Brenda Marquardt, A.N.P.
-
Lenae Anne Lee, RD, LD
-
Carlee Lynn Thomson, DNP, APRN, FNP-C
-
Lisa Ann Burchett, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161206002392 | TX | Part B Supplier - Clinic/Group Practice | 2466550801 |
Receives reassigned benefits from 26 practitioners Practice locations: Fort Totten, ND |
National Provider Directory
- Part of
- Spirit Lake Okiciyapi
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | Yes | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Podiatric Clinic/Center | 261QP1100X | |||
| Mammography Clinic/Center | 261QR0206X | |||
| Clinical Medical Laboratory | 291U00000X |
Addresses
Primary practice location
3883 74TH Ave NE
Fort Totten, ND 58335
Mailing address
PO Box 309
Fort Totten, ND 58335-0309
Phone (701) 766-1600
Other names
- Spirit Lake Health Center
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ftc@directihs.net | Direct |
Other providers in Fort Totten, ND
- Spirit Lake Tribe
- Spirit Lake Tribe
- Spirit Lake Tribe
- Spirit Lake Tribe
- Spirit Lake Tribe
- Spirit Lake Tribe
- Spirit Lake Tribe
- Spirit Lake Tribe
- Spirit Lake Tribe
- Spirit Lake Tribe
All providers in Fort Totten, ND · Health Service Clinic/Center in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.