# WHITE EARTH BAND OF CHIPPEWA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** White Earth Reservation Ambulance Service
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033129556
- **Authorized official:** KIM HOGLUND (BILLING MANAGER)
- **Authorized official phone:** (218) 936-5586

## Contact information

- **Practice address:** 26246 CRANE RD, WHITE EARTH, MN 56591-9998
- **Practice address phone:** (218) 983-3285
- **Practice address fax:** (218) 983-4299
- **Mailing address:** PO BOX 328, WHITE EARTH, MN 56591-0328
- **Mailing address phone:** (218) 983-3285
- **Mailing address fax:** (218) 983-4299

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 0354 | MN | Yes |

## Other

- **Enumeration date:** 08/08/2006
- **Last updated:** 01/07/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 56M66WH | BLUE CROSS BLUE SHIELD | MN |
| 01 | — | 8183263 | MEDICA | MN |