Organization
PONEMAH CLINIC
Active
Organization
PONEMAH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN DUDLEY (MEDICAL STAFF COOR.)
(218) 679-3912
Entity
Organization
Contact information
Practice address
HWY 1, BOX 497, RED LAKE, MN 56671
(218) 679-3912
(218) 679-0181
Mailing address
HWY 1, BOX 497, RED LAKE, MN 56671
(218) 679-3912
(218) 679-0181
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
07/05/2007
Last updated
08/14/2008
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