Organization
SAWTOOTH MOUNTAIN CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF STODDARD (CFO)
(218) 877-8263
Entity
Organization
Contact information
Practice address
513 5TH AVE W, GRAND MARAIS, MN 55604-3017
(218) 387-2330
(218) 387-1278
Mailing address
513 5TH AVE W, GRAND MARAIS, MN 55604-3017
(218) 387-2330
(218) 387-1278
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
22021
MN
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
241806
MEDICARE/OSCAR CERTIFICATION
MN
01
—
4F029TE
DR. TERRILL-BCBS
MN
05
—
536253900
—
MN
05
—
639097800
—
MN
05
—
744708600
—
MN
05
—
785090500
—
MN
05
—
844318100
—
MN
05
—
873397000
—
MN
01
—
BC69144CO
GROUP CLAIMS-BCBS
MN
Enumeration date
09/21/2005
Last updated
01/03/2025
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