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
13071 NETT LAKE ROAD, SUITE B, NETT LAKE, MN 55772
(218) 757-3295
(218) 757-0234
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
—
004218800
101YA0400X
MN
Enumeration date
04/26/2007
Last updated
05/15/2018
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