SPIRIT LAKE HEALTH CENTER PHARMACY (NPI# 1568592137) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568592137 |
| Entity Type | Organization |
| Organization Name | SPIRIT LAKE HEALTH CENTER PHARMACY |
| Other Organization Name | SPIRIT LAKE HEALTH CENTER PHARMACY |
| Practice Address |
3883 74th Ave Ne Fort Totten ND 58335 |
| Mailing Address |
Spirit Lake Health Ctr 3100 Solutions Center Chicago IL 60677-3001 |
| Practice Telephone | 7017661612 |
| Practice Fax Number | 7017661625 |
| Mailing Telephone | 7017661612 |
| Mailing Fax Number | 7017661625 |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2013-03-07 |
| Authorized Official Name | JAMES CUMMINGS (PHARMACY PROGRAM SPECIALIST) |
| Authorized Official Telephone | 4059516086 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 01051 | 05 | |
| ND | 1061SP | 05 | |
| NCPDP PROVIDER IDENTIFICATION NUMBER | 3503693 | 01 |
| Other Name | Type Code |
|---|---|
| SPIRIT LAKE HEALTH CENTER PHARMACY | Doing Business As Name - Organization |
| Street Address |
3883 74TH AVE NE |
| City | FORT TOTTEN |
| State | ND |
| Zip Code | 58335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124646146 | Liza A Ystaas | Nurse Practitioner | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2020-07-07 |
| 1205453172 | Mikkel Elizabeth Buckmier | Nurse Practitioner | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2020-06-26 |
| 1821622010 | Spirit Lake Tribe | Non-emergency Medical Transport (VAN) | 3883 74th Ave Ne, Fort Totten, ND 58335-0309 | 2020-02-26 |
| 1144874108 | Sarah Ruth Cavanaugh | Dentist | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2019-07-29 |
| 1629508452 | Jacqueline Patrice Schroeder | Registered Nurse | 3883 74th Ave Ne, Fort Totten, ND 58335-5833 | 2017-06-14 |
| 1831629732 | Ashley Storbakken | Registered Nurse | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2017-06-14 |
| 1740710649 | Kyla Sarah Delorme | Registered Nurse | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2017-06-14 |
| 1386174316 | Chelsea Rose Young | Licensed Practical Nurse | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2017-06-13 |
| 1518496207 | Angela I Cross | Licensed Practical Nurse | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2017-06-07 |
| 1225576341 | Spirit Lake Tribe | Internal Medicine | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2017-02-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356941116 | Sherry Yvonne Longie | Technician | 213 Dakotah Dr. #53, Fort Totten, ND 58335 | 2020-10-29 |
| 1235650250 | Tiffaney Anne Two Eagle | Registered Nurse | 3883 74th Avenue Northeast, Fort Totten, ND 58335 | 2017-06-29 |
| 1093015265 | Spirit Lake Head Start | Clinic/Center | 816 3rd Ave North, Fort Totten, ND 58335 | 2010-10-22 |
| 1154532000 | Nancy C Dauphinais | Technician, Pathology | 3883 74th Avenue North East, Fort Totten, ND 58335 | 2007-05-24 |
| 1467575159 | Jeanette Lucille Rosenheim | Registered Nurse | Spirit Lake Health Center, 3883 74th Ave Ne Box 309, Fort Totten, ND 58335 | 2007-04-09 |
| 1184744518 | Tammy Delaine Lawrence | Registered Nurse | 3883 74th Avenue Ne, Fort Totten, ND 58335 | 2007-03-30 |
| 1821127036 | Evangeline S. Gaid | Family Medicine | 3883 74th Ave.ne, Ft. Totten, ND 58335 | 2007-03-05 |
| 1538296199 | Cheri J Schaffer | Registered Nurse | 3883 74th Ave North East, Fort Totten, ND 58335 | 2007-02-28 |
| 1720152457 | Spirit Lake Tribe | Case Management | 416 2nd Avenue North, Fort Totten, ND 58335 | 2006-11-17 |
| 1740387059 | Spirit Lake Tribe | Ambulance | 7686 Ephriam Hill Road, Fort Totten, ND 58335 | 2006-09-20 |
| Find all providers in zip 58335 | ||||
| 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 |
|---|---|---|---|---|
| 1770613325 | Fort Yates Indian Hosp Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1010 N River Rd, Fort Yates, ND 58538 | 2007-03-06 |
| 1790811503 | Belcourt Ihs Hospital | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1st Main St Highway 5, Belcourt, ND 58316 | 2007-02-26 |
| 1124284914 | Three Affiliated Tribes White Shield Healthcare Telepharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2 Main Street B, Roseglen, ND 58775 | 2008-08-01 |
| 1811153505 | Three Affiliated Tribes Twin Buttes Healthcare Tele-pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 726 80th Ave Nw, Halliday, ND 58636-4001 | 2008-08-01 |
| 1801052592 | Three Affiliated Tribes Parshall Healthcare Tele-pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 107 3rd St Se, Parshall, ND 58770 | 2008-08-01 |
| 1063678779 | Three Affiliated Tribes Manadree Health Care Tele-pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 305 Main Street, Mandaree, ND 58757 | 2008-08-01 |
| 1467611970 | Elbowoods Memorial Health Center Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1058 College Dr, New Town, ND 58763-9112 | 2008-06-09 |
| 1689895427 | Trenton Community Clinic Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 331 4th Ave E, Hwy 1804, Trenton, ND 58853-9998 | 2007-05-01 |
| 1851428288 | Fort Berthold Ihs Health Center Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1 Minni Tohe Dr, New Town, ND 58763-4400 | 2007-02-27 |
| City | FORT TOTTEN |
| Zip Code | 58335 |
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| 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.