Organization
WHITE EARTH HEALTH CENTER
Active
Organization
WHITE EARTH HEALTH CENTER
Active
Other names
Pine Point Health Station
Organization subpart
No
Provider details
NPI number
Authorized official
BRYCE J REDGRAVE (CHIEF EXECUTIVE OFFICER (CEO))
(218) 983-6214
Entity
Organization
Contact information
Practice address
47520 282 STREET, PONSFORD, MN 56575
(218) 573-2162
(218) 573-3888
Mailing address
40520 COUNTY HIGHWAY 34, OGEMA, MN 56569-9612
(218) 573-2162
(218) 573-3888
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246753400
—
MN
01
—
5511210001
DMEPOS SUPPLIER NUMBER
MN
Enumeration date
05/11/2007
Last updated
11/24/2009
Update your record
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