NPIMap

Organization Active NPI

PHS Indian Hospital

Doing business as PHS Indian Hospital-Behavior Health Clinic

  • Psychologist
  • Red Lake, MN
National Provider Identifier
1679099568
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
PHS INDIAN HOSPITAL
Doing business as
PHS Indian Hospital-Behavior Health Clinic
Practice address
PO Box 497
Redlake, MN 56671-0497
Phone
(218) 679-3912
Fax
(218) 679-0181
NPI assigned
Aug 22, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Janice Marie Thunder
Title
Business Office Manager
Phone
(218) 679-3912

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X MN Primary

Addresses

Primary practice location

PO Box 497
Redlake, MN 56671-0497

Mailing address

24760 Hospital Drive
Box 497 C/O Business Office
Red Lake, MN 56670
Phone (218) 679-3912

Other names 1

  • PHS INDIAN HOSPITAL-BEHAVIOR HEALTH CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Emcare5 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.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1679099568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24760 HOSPITAL DRIVE",
            "address_2": "BOX 497 C/O BUSINESS OFFICE",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "56670",
            "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": "PO BOX 497",
            "city": "REDLAKE",
            "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": "2017-08-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "THUNDER",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "218-679-3912"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHS INDIAN HOSPITAL-BEHAVIOR HEALTH CLINIC",
            "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 Jul 21, 2022; 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.