Active NPI
Cook Area Health Services, Inc
- Clinic/Center
- Floodwood, MN
National Provider Identifier
1174596027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- COOK AREA HEALTH SERVICES, INC
- Practice address
- 810 Poplar St
Floodwood, MN 55736-4002 - Phone
- (218) 476-2221
- Fax
- (218) 476-2965
- NPI assigned
- Feb 10, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Keith D Harvey
- Title
- Ceo
- Phone
- (218) 361-3135
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
810 Poplar St
Floodwood, MN 55736-4002
Mailing address
126 W 7TH Ave
Box 426
Floodwood, MN 55736-0426
Phone (218) 476-2221
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 288604900 | Medicaid | MN | |
| 241826 | Other | MEDICARE |
Other names 1
- Scenic Rivers Health Services
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040427001470 | MN | Part B Supplier - Clinic/Group Practice | 4880681303 |
Receives reassigned benefits from 35 practitioners 6 other NPIs on this enrollment Practice locations: Eveleth, MN; Tower, MN; Northome, MN; Floodwood, MN; Cook, MN; Bigfork, MN; Big Falls, MN |
| O20040707000157 | MN | Part A Provider - Federally Qualified Health Center (FQHC) | 4880681303 | Practice locations: Floodwood, MN |
Federally qualified health center certification: CCN 241826
- Legal name
- COOK AREA HEALTH SERVICES, INC
- Doing business as
- SCENIC RIVERS HEALTH SERVICES
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 4, 2002
- Last certification
- Jan 4, 2002
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Mar 1, 1979 in MN
- Enrollment address
- 810 Poplar Street
Floodwood, MN 55736-0426 - Related CCNs
- 241802
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
Other NPIs with the same Medicare PAC ID 6
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
239 McKinley Ave
Eveleth, MN 55734
Phone (218) 361-3300
Ownership & related parties
All disclosed owners & managing parties 12
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Stephanie a Burckhardt | Corporate Director | Jan 1, 2015 | |
| Wende Nelson | Corporate Director | Jan 1, 2016 | |
| Nancy L Mault | W-2 Managing Employee | Jul 1, 2014 | |
| Operational/Managerial Control | Jul 1, 2014 | ||
| Mary G Blackmer | Corporate Director | Jun 23, 2010 | |
| Karen M Lorenzen | Corporate Director | Jun 23, 2010 | |
| Richard V Hanson | Corporate Director | Jan 1, 2017 | |
| Marian a Swang | Corporate Director | Jun 23, 2010 | |
| Michael a Holmes | Corporate Officer | Jun 23, 2010 | |
| W-2 Managing Employee | May 1, 1979 | ||
| Operational/Managerial Control | May 1, 1979 | ||
| Diane J Gallagher | Corporate Director | Jan 1, 2017 | |
| William H Tibbetts | Corporate Director | Jun 23, 2010 | |
| Keith D Harvey | W-2 Managing Employee | Jul 21, 2014 | |
| Operational/Managerial Control | Jul 21, 2014 | ||
| Dianne L Bakke | Corporate Director | Jan 1, 2015 |
Practitioners & affiliated clinicians
Practitioners 38
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139529600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1754524800000",
"number": "1174596027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 W 7TH AVE",
"address_2": "BOX 426",
"city": "FLOODWOOD",
"state": "MN",
"postal_code": "557360426",
"telephone_number": "218-476-2221",
"fax_number": "218-476-2965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 POPLAR ST",
"city": "FLOODWOOD",
"state": "MN",
"postal_code": "557364002",
"telephone_number": "218-476-2221",
"fax_number": "218-476-2965"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COOK AREA HEALTH SERVICES, INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-10",
"last_updated": "2025-08-07",
"certification_date": "2025-08-07",
"status": "A",
"authorized_official_last_name": "HARVEY",
"authorized_official_first_name": "KEITH",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "218-361-3135"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "288604900",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "241826",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Scenic Rivers Health Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Floodwood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.