NPIMap

Organization Active NPI

White Earth Health Center

  • Durable Medical Equipment & Medical Supplies
  • Ponsford, MN
National Provider Identifier
1275748543
Registry record updated Nov 24, 2009
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
47520 282 Street
Ponsford, MN 56575
Phone
(218) 573-2162
Fax
(218) 573-3888
NPI assigned
May 11, 2007
Last updated
Nov 24, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2009

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

Authorized official

Name
Bryce J Redgrave
Title
Chief Executive Officer (Ceo)
Phone
(218) 983-6214

Specialties & licenses 1

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

Addresses

Primary practice location

47520 282 Street
Ponsford, MN 56575

Mailing address

40520 County Highway 34
Ogema, MN 56569-9612
Phone (218) 573-2162

Other identifiers 2

IdentifierTypeStateIssuer
5511210001OtherMNDMEPOS SUPPLIER NUMBER
246753400MedicaidMN

Other names 1

  • Pine Point Health Station Other name

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": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259020800000",
    "number": "1275748543",
    "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": "218-573-2162",
            "fax_number": "218-573-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47520 282 STREET",
            "city": "PONSFORD",
            "state": "MN",
            "postal_code": "56575",
            "telephone_number": "218-573-2162",
            "fax_number": "218-573-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE EARTH HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2009-11-24",
        "status": "A",
        "authorized_official_last_name": "REDGRAVE",
        "authorized_official_first_name": "BRYCE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER (CEO)",
        "authorized_official_telephone_number": "218-983-6214"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMEPOS SUPPLIER NUMBER",
            "identifier": "5511210001",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "246753400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Point Health Station",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ponsford, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.