NPIMap

Organization Active NPI

PHS Indian Hospital

  • General Acute Care Hospital
  • Red Lake, MN
National Provider Identifier
1508809765
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PHS INDIAN HOSPITAL
Doing business as
PHS Indian Hospital
Practice address
Hwy 1 Hospital Dr
Box 497
Red Lake, MN 56671-0497
Phone
(218) 679-3912
Fax
(218) 679-0181
NPI assigned
Jun 14, 2006
Last updated
Apr 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

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

Authorized official

Name
Mary Ann Cook, DR.
Title
Ceo
Phone
(218) 679-0107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X MN Primary

Addresses

Primary practice location

Hwy 1 Hospital Dr
Box 497
Red Lake, MN 56671-0497

Mailing address

Hwy 1 Hospital Dr
Box 497
Red Lake, MN 56671
Phone (218) 679-3912

Other names 1

  • PHS INDIAN HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031114000287 TX Part B Supplier - Clinic/Group Practice 4789598731 Receives reassigned benefits from 57 practitioners
Practice locations: Ponemah, MN; Redlake, MN
O20080611000398 MN Part A Provider - Indian Health Services Facility 4789598731 Practice locations: Red Lake, MN

Other NPIs with the same Medicare PAC ID 1

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

  • PHS Indian Hospital

    dba Red Lake Indian Hospital Pharmacy

    • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
    • Red Lake, MN
    • NPI 1063549822

    4789598731

    Same PAC ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 102

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 102

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776297600000",
    "number": "1508809765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HWY 1 HOSPITAL DR",
            "address_2": "BOX 497",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "56671",
            "telephone_number": "218-679-3912",
            "fax_number": "218-679-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 1 HOSPITAL DR",
            "address_2": "BOX 497",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "566710497",
            "telephone_number": "218-679-3912",
            "fax_number": "218-679-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS INDIAN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-679-0107",
        "authorized_official_credential": "DR."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHS INDIAN HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Red Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.