NPIMap

Organization Active NPI

White Earth Health Center

  • Durable Medical Equipment & Medical Supplies
  • Ogema, MN
National Provider Identifier
1205042728
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
WHITE EARTH HEALTH CENTER
Practice address
40520 County Highway 34
Ogema, MN 56569-9612
Phone
(218) 983-4300
Fax
(218) 983-6217
NPI assigned
May 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Fred C Koebrick
Title
Ceo
Phone
(218) 983-6214

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

40520 County Highway 34
Ogema, MN 56569-9612

Mailing address

40520 County Highway 34
Ogema, MN 56569-9612
Phone (218) 983-4300

Other identifiers 2

IdentifierTypeStateIssuer
5511210003OtherMNDMEPOS SUPPLIER NUMBER
6B303WHOtherMNBCBS

Other names 1

  • White Earth IHS Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0669265White Earth IHS Main Lab40520 County Highway 34, Ogema, MN 56569Certificate of waiverApr 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
White Earth Indian Health Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205042728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40520 COUNTY HIGHWAY 34",
            "city": "OGEMA",
            "state": "MN",
            "postal_code": "565699612",
            "telephone_number": "218-983-4300",
            "fax_number": "218-983-6217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40520 COUNTY HIGHWAY 34",
            "city": "OGEMA",
            "state": "MN",
            "postal_code": "565699612",
            "telephone_number": "218-983-4300",
            "fax_number": "218-983-6217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE EARTH HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOEBRICK",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-983-6214",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMEPOS SUPPLIER NUMBER",
            "identifier": "5511210003",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "6B303WH",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Earth IHS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ogema, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.