# ESSENTIA HEALTH MOOSE LAKE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ESSENTIA HEALTH
- **Other names:** ESSENTIA HEALTH MOOSE LAKE CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275102048
- **Legal business name:** ESSENTIA HEALTH
- **Authorized official:** KEVIN BOREN (VP OF FINANCE)
- **Authorized official phone:** (218) 786-1009

## Contact information

- **Practice address:** 4572 COUNTY ROAD 61, MOOSE LAKE, MN 55767-9401
- **Practice address phone:** (218) 485-2105
- **Practice address fax:** (218) 485-2106
- **Mailing address:** 4572 COUNTY ROAD 61, MOOSE LAKE, MN 55767-9401
- **Mailing address phone:** (218) 485-2105
- **Mailing address fax:** (218) 485-2170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC0050X | Critical Access Hospital Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/24/2021
- **Last updated:** 02/27/2026