Provider Demographics
NPI:1174866271
Name:NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:NORTHLAND HEALTH PARTNERS COMMUNITY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-448-2054
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-0535
Mailing Address - Country:US
Mailing Address - Phone:701-448-2054
Mailing Address - Fax:701-448-2056
Practice Address - Street 1:18 MAIN ST SW STE B
Practice Address - Street 2:
Practice Address - City:BOWBELLS
Practice Address - State:ND
Practice Address - Zip Code:58721
Practice Address - Country:US
Practice Address - Phone:701-377-6400
Practice Address - Fax:701-377-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5924Medicaid
ND351815Medicare Oscar/Certification