SPIRIT LAKE TRIBE (NPI# 1912458407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912458407 |
| Entity Type | Organization |
| Organization Name | SPIRIT LAKE TRIBE |
| Other Organization Name | SPIRIT LAKE HEALTH CENTER |
| Practice Address |
3883 74th Ave Ne Fort Totten ND 58335 |
| Mailing Address |
Po Box 309 Fort Totten ND 58335-0309 |
| Practice Telephone | 7017661600 |
| Practice Fax Number | 7017661630 |
| Mailing Telephone | 7017661600 |
| Mailing Fax Number | 7017661630 |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |
| Authorized Official Name | MICHELLE BELT (CEO) |
| Authorized Official Telephone | 7017661600 |
| Is Organization Subpart | Y |
| Parent Organization Name | SPIRIT LAKE TRIBE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Spirit Lake Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053515783 | Spirit Lake Tribe | Ambulance | 1403 Brunswick Ave, Fort Totten, ND 58335-0449 | 2007-06-14 |
| 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 |
| 1821622010 | Spirit Lake Tribe | Non-emergency Medical Transport (VAN) | 3883 74th Ave Ne, Fort Totten, ND 58335-0309 | 2020-02-26 |
| 1225576341 | Spirit Lake Tribe | Internal Medicine | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2017-02-09 |
| 1417408907 | Spirit Lake Tribe | Optometrist | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| 1144771650 | Spirit Lake Tribe | Social Worker | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| 1609327196 | Spirit Lake Tribe | Psychiatry & Neurology | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| 1508317090 | Spirit Lake Tribe | Dentist | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| 1063963551 | Spirit Lake Tribe | Physician Assistant | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SPIRIT LAKE TRIBE | 816 3 Ave N, Fort Totten, ND 58335-9998 |
| 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 | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710213715 | Henry David Knudsen | Radiology | 3207 46th Ave Se, Mandan, ND 58554-4729 | 2009-10-26 |
| 1104054477 | James Allen Miller | Radiology | #1 Burdick Expy W., Minot, ND 58701-4406 | 2009-06-25 |
| 1992836100 | Robert Lowell Anderson | Radiology | One West Burdick Expressway, Minot, ND 58702-5020 | 2007-03-08 |
| 1841388089 | Garren C Ruggaber | Radiology | 1191 S Columbia Rd, Grand Forks, ND 58201-4033 | 2006-10-11 |
| 1902826340 | Edward F Fogarty | Radiology | 800 Munich Dr, Bismarck, ND 58504-7050 | 2006-07-20 |
| 1346267812 | Francisco V Ouano | Radiology | 2907 32nd St S, Fargo, ND 58103-7863 | 2006-07-17 |
| 1114942372 | Kathleen Ann Wood | Radiology | 705 13th Ave N, Apt. 310, Fargo, ND 58102-2680 | 2006-07-12 |
| 1376578484 | Royce L Zobell | Radiology | #1 Burdick Expy W, Minot, ND 58701 | 2006-07-11 |
| 1003899584 | Radiology Services, P.a. | Radiology | 419 5th St Ne, Jamestown, ND 58401-3300 | 2005-11-29 |
| 1366423618 | Prairie Imaging, PC | Radiology | 112 3rd St W, Dickinson, ND 58601-5136 | 2005-11-11 |
| Find all providers with the same taxonomy | ||||
| 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.