NPIMap

Organization Active NPI

Ponemah Clinic

  • Health Service Clinic/Center
  • Red Lake, MN
National Provider Identifier
1760680300
Registry record updated Aug 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
PONEMAH CLINIC
Practice address
Hwy 1
Box 497
Red Lake, MN 56671
Phone
(218) 679-3912
Fax
(218) 679-0181
NPI assigned
Jul 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2008

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

Authorized official

Name
Kathleen Dudley
Title
Medical Staff Coor.
Phone
(218) 679-3912

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

Hwy 1
Box 497
Red Lake, MN 56671

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Indian Health Service5 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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218672000000",
    "number": "1760680300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HWY 1",
            "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",
            "address_2": "BOX 497",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "56671",
            "telephone_number": "218-679-3912",
            "fax_number": "218-679-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONEMAH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2008-08-14",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "MEDICAL STAFF COOR.",
        "authorized_official_telephone_number": "218-679-3912"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 14, 2008; 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.