BOIS FORTE RESERVATION TRIBAL GOVERNMENT (NPI# 1073530150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073530150 |
| Entity Type | Organization |
| Organization Name | BOIS FORTE RESERVATION TRIBAL GOVERNMENT |
| Practice Address |
5219 St. John Dr Nett Lake MN 55772 |
| Mailing Address |
5219 Saint John Dr Orr MN 55771-8232 |
| Practice Telephone | 2187573650 |
| Mailing Telephone | 2187573650 |
| Mailing Fax Number | 2187570222 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-06-18 |
| Authorized Official Name | CATHERINE CHAVERS (TRIBAL CHAIRMAN) |
| Authorized Official Telephone | 2187573361 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 177515400 | 05 | |
| MN | BCBS | 63G35BO | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144765843 | Bois Forte Reservation Tribal Government | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1224 White Pine Cir, Tower, MN 55790 | 2017-01-04 |
| 1750907010 | Bois Forte Reservation Tribal Government | Pharmacy | 1613 Farm Rd S, Tower, MN 55790-5579 | 2020-06-23 |
| 1265058903 | Bois Forte Reservation Tribal Government | Pharmacy | 5219 Saint John Dr, Orr, MN 55771-8232 | 2020-06-18 |
| Street Address |
5219 ST. JOHN DR |
| City | NETT LAKE |
| State | MN |
| Zip Code | 55772 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396286357 | Joe Witt | Psychologist | 5219 St. John Drive, Nett Lake, MN 55772 | 2017-03-10 |
| 1346600962 | Julie Corradi | Pharmacist | 5219 St. Johns Drive, Nett Lake, MN 55772 | 2016-02-24 |
| 1205134152 | Melissa Joan Grzybowski | Dietitian, Registered | 5219 St. John's Drive, Nett Lake, MN 55772 | 2011-03-02 |
| 1871713321 | Bois Forte Reservation Tribal Council | Clinic/Center | 13071 Nett Lake Road, Suite B, Nett Lake, MN 55772 | 2007-04-26 |
| 1972666469 | Bois Forte Medical Clinic | Clinic/Center | 5219 St John Dr, Nett Lake, MN 55772 | 2006-12-18 |
| 1649270901 | Bois Forte Reservation Tribal Council | Community/Behavioral Health | 13071 Nett Lake Road, Suite B, Nett Lake, MN 55772 | 2005-07-28 |
| 1912170549 | Peggy J Hiestand Harri | Dietitian, Registered | 13071 Nett Lake Rd, Nett Lake, MN 55772 | 2008-04-03 |
| 1528288073 | Bois Forte Human Services | Social Worker | 13090 Westley Drive, Suite B, Nett Lake, MN 55772 | 2007-04-26 |
| 1255815387 | Bois Forte Reservation Tribal Council | Non-emergency Medical Transport (VAN) | 5344 Lake Shore Dr, Nett Lake, MN 55772-1200 | 2018-09-25 |
| 1821153347 | St. Louis & Koochiching Cos Ind School Dist 707 | Local Education Agency (LEA) | 13090 Westley Drive, Nett Lake, MN 55772-8122 | 2006-12-26 |
| Find all providers in zip 55772 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972139814 | Red Lake Band of Chippewa Indians | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 34966 605th Ave, Warroad, MN 56763-9022 | 2020-03-22 |
| 1184250029 | Red Lake Band of Chippewa Indians | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 10200 Highway 89, Redlake, MN 56671-2500 | 2020-03-22 |
| 1437785375 | Red Lake Band of Chippewa Indians | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 20595 Center St E, Thief River Falls, MN 56701-8016 | 2020-03-22 |
| 1376026153 | Children's Healing Center | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 25060 Hwy 1 East, Red Lake, MN 56671 | 2018-09-08 |
| 1730696154 | Red Lake Chemical Health Programs | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 14414 Green Lake Road, Redby, MN 56670 | 2018-01-08 |
| 1144765843 | Bois Forte Reservation Tribal Government | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1224 White Pine Cir, Tower, MN 55790 | 2017-01-04 |
| 1629256763 | Fond Du Lac Reservation Business Committee | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 221 W 4th St, Duluth, MN 55806-2719 | 2008-01-31 |
| 1164920963 | Nacc Tribal Health Services | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1213 E Franklin Ave, Minneapolis, MN 55404-2923 | 2018-01-26 |
| 1386152833 | Nacc Medication Assisted Recovery Services | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1213 E Franklin Ave, Minneapolis, MN 55404-2923 | 2018-01-18 |
| 1700394640 | Red Lake Chemical Health Programs | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 15797 Main Ave, Red Lake, MN 56671-0114 | 2018-01-12 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on BOIS FORTE RESERVATION TRIBAL GOVERNMENT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.