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
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
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 1

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

Practitioners 101

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 101

Medicare participation

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

Medicare enrollment records 2

Medicare enrollment files
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

National Provider Directory

National Provider Directory

Locations

4100 W 150th St
Cleveland, OH 44135

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

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 identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
5A54HPUOtherMNBC/BS OF MN
25F45REOtherMNBC/BS OF MN
476753500MedicaidMN

Other names 1

NPPES NPI Registry
  • PHS INDIAN HOSPITAL Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 16, 2026.

{
    "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MN",
            "identifier": "5A54HPU",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MN",
            "identifier": "25F45RE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "476753500",
            "state": "MN"
        }
    ],
    "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.