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Organization
BOIS FORTE RESERVATION TRIBAL COUNCIL
Active
Organization
BOIS FORTE RESERVATION TRIBAL COUNCIL
Active
Other names
Bois Forte Human Services
Organization subpart
No
Provider details
NPI number
Authorized official
LYNETTE TAHTINEN CPCS (DATA & FINANCE SPECIALIST)
(218) 757-3295
Entity
Organization
Contact information
Practice address
1195 COUNTY ROAD 77, TOWER, MN 55790
(218) 757-0111
(218) 757-0109
Mailing address
5219 ST JOHN DRIVE, NETT LAKE, MN 55772-8232
(218) 757-3295
(218) 757-0234
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036862800
101YA0400X
MN
Enumeration date
05/04/2007
Last updated
05/15/2018
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