| Spirit Lake Health Center | |
|
3883 74th Ave Ne Ft Totten ND 58301 | |
| (701) 766-1612 | |
| Not Available |
| Full Name | Spirit Lake Health Center |
|---|---|
| Speciality | Clinic/center - Public Health, Federal |
| Location | 3883 74th Ave Ne, Ft Totten, North Dakota |
| Authorized Official Name and Position | Darren Martell (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 7017661600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spirit Lake Health Center Po Box 309 3883 74th Ave Ne Fort Totten ND 58335-0309 Ph: () - | Spirit Lake Health Center 3883 74th Ave Ne Ft Totten ND 58301 Ph: (701) 766-1612 |
| NPI Number | 1548323314 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548323314 | NPI | - | NPPES |
| 01056 | Medicaid | ND | |
| 3503693 | Other | ND | NCPDP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0904X | Clinic/center - Public Health, Federal | AU46983207 (* (Not Available)) | Primary |