Organization
WHITE EARTH HEALTH CENTER
Active
Other names
White Earth IHS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRED C KOEBRICK (CEO)
(218) 983-6214
Entity
Organization
Contact information
Practice address
40520 COUNTY HIGHWAY 34, OGEMA, MN 56569-9612
(218) 983-4300
(218) 983-6217
Mailing address
40520 COUNTY HIGHWAY 34, OGEMA, MN 56569-9612
(218) 983-4300
(218) 983-6217
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5511210003
DMEPOS SUPPLIER NUMBER
MN
01
—
6B303WH
BCBS
MN
Enumeration date
05/14/2007
Last updated
08/22/2020
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