SPIRIT LAKE TRIBE (NPI# 1841619798) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841619798 |
| Entity Type | Organization |
| Organization Name | SPIRIT LAKE TRIBE |
| Other Organization Name | SPIRIT LAKE HEALTH CENTER |
| Practice Address |
3883 74th Avenue Ne Fort Totten ND 58335 |
| Mailing Address |
816 3rd Ave N Fort Totten ND 58335 |
| Practice Telephone | 7017661600 |
| Practice Fax Number | 7017661630 |
| Mailing Telephone | 7017664236 |
| Mailing Fax Number | 7017664878 |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2016-06-10 |
| Authorized Official Name | MRS. ARDELL M BLUESHIELD (TRIBAL HEALTH DIRECTOR) |
| Authorized Official Telephone | 7017664236 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
ND | Ambulatory Health Care Facilities | |
| N | 261QP0905X |
Clinic/Center Specialization: Public Health, State or Local |
ND | Ambulatory Health Care Facilities | |
| N | 261QP1100X |
Clinic/Center Specialization: Podiatric |
ND | Ambulatory Health Care Facilities | |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
ND | Ambulatory Health Care Facilities | |
| N | 261QR0206X |
Clinic/Center Specialization: Radiology, Mammography |
ND | Ambulatory Health Care Facilities | |
| N | 291U00000X | Clinical Medical Laboratory | ND | Laboratories | |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | ND | Suppliers | |
| N | 3416L0300X |
Ambulance Specialization: Land Transport |
ND | Transportation Services | |
| N | 343900000X | Non-emergency Medical Transport (VAN) | Transportation Services | ||
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
ND | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 1466035 | 05 |
| Other Name | Type Code |
|---|---|
| Spirit Lake Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053515783 | Spirit Lake Tribe | Ambulance | 1403 Brunswick Ave, Fort Totten, ND 58335-0449 | 2007-06-14 |
| 1720152457 | Spirit Lake Tribe | Case Management | 416 2nd Avenue North, Fort Totten, ND 58335 | 2006-11-17 |
| 1740387059 | Spirit Lake Tribe | Ambulance | 7686 Ephriam Hill Road, Fort Totten, ND 58335 | 2006-09-20 |
| 1821622010 | Spirit Lake Tribe | Non-emergency Medical Transport (VAN) | 3883 74th Ave Ne, Fort Totten, ND 58335-0309 | 2020-02-26 |
| 1225576341 | Spirit Lake Tribe | Internal Medicine | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2017-02-09 |
| 1417408907 | Spirit Lake Tribe | Optometrist | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| 1144771650 | Spirit Lake Tribe | Social Worker | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| 1609327196 | Spirit Lake Tribe | Psychiatry & Neurology | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| 1508317090 | Spirit Lake Tribe | Dentist | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| 1912458407 | Spirit Lake Tribe | Radiology | 3883 74th Ave Ne, Fort Totten, ND 58335 | 2016-10-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SPIRIT LAKE TRIBE | 816 3 Ave N, Fort Totten, ND 58335-9998 |
| Street Address |
3883 74TH AVENUE NE |
| City | FORT TOTTEN |
| State | ND |
| Zip Code | 58335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184744518 | Tammy Delaine Lawrence | Registered Nurse | 3883 74th Avenue Ne, Fort Totten, ND 58335 | 2007-03-30 |
| 1093201840 | Shelby Marie Gillett | Pharmacist | 3883 74th Avenue Ne, Fort Totten, ND 58335 | 2018-07-05 |
| 1992248967 | Necito L Montaniel | General Practice | 3883 74th Avenue Ne, Fort Totten, ND 58335 | 2016-11-23 |
| 1770804387 | Tiffani D. Showalter | Physician Assistant | 3883 74th Avenue Ne, Fort Totten, ND 58335 | 2010-06-17 |
| 1174749501 | Sherrie R. Landsem Walford | Pathology | 3883 74th Avenue Ne, Box 309, Fort Totten, ND 58335-0309 | 2007-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356941116 | Sherry Yvonne Longie | Technician | 213 Dakotah Dr. #53, Fort Totten, ND 58335 | 2020-10-29 |
| 1235650250 | Tiffaney Anne Two Eagle | Registered Nurse | 3883 74th Avenue Northeast, Fort Totten, ND 58335 | 2017-06-29 |
| 1093015265 | Spirit Lake Head Start | Clinic/Center | 816 3rd Ave North, Fort Totten, ND 58335 | 2010-10-22 |
| 1154532000 | Nancy C Dauphinais | Technician, Pathology | 3883 74th Avenue North East, Fort Totten, ND 58335 | 2007-05-24 |
| 1467575159 | Jeanette Lucille Rosenheim | Registered Nurse | Spirit Lake Health Center, 3883 74th Ave Ne Box 309, Fort Totten, ND 58335 | 2007-04-09 |
| 1821127036 | Evangeline S. Gaid | Family Medicine | 3883 74th Ave.ne, Ft. Totten, ND 58335 | 2007-03-05 |
| 1538296199 | Cheri J Schaffer | Registered Nurse | 3883 74th Ave North East, Fort Totten, ND 58335 | 2007-02-28 |
| 1720152457 | Spirit Lake Tribe | Case Management | 416 2nd Avenue North, Fort Totten, ND 58335 | 2006-11-17 |
| 1689762171 | Cynthia Anne Gunderson | Pharmacist | 3883 74th Ave Ne, Ft Totten, ND 58335 | 2006-10-10 |
| 1740387059 | Spirit Lake Tribe | Ambulance | 7686 Ephriam Hill Road, Fort Totten, ND 58335 | 2006-09-20 |
| Find all providers in zip 58335 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093015265 | Spirit Lake Head Start | Clinic/Center | 816 3rd Ave North, Fort Totten, ND 58335 | 2010-10-22 |
| 1073665493 | Spirit Lake Health Center | Clinic/Center | 3883 74th Ave Ne, Fort Totten, ND 58335-0309 | 2007-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124640479 | Bright Life Family Chiropractic, PC | Clinic/Center | 3001 Yorktown Dr Ste 3, Bismarck, ND 58503-8518 | 2020-05-09 |
| 1265678056 | Strinden Vision | Clinic/Center | 3221 32nd Ave S, Suite 300, Grand Forks, ND 58201-6071 | 2008-12-28 |
| 1972090181 | Blue Apple Wellness, LLP | Clinic/Center | 1650 45th St S Ste 113, Fargo, ND 58103-3247 | 2018-04-13 |
| 1447522206 | Ian L Greybull | Clinic/Center | 300 W Century Ave, Bismarck, ND 58503-1405 | 2012-02-08 |
| 1245526201 | All Seasons Full Body Chiropractic Center LLC | Clinic/Center | 1102 43rd St S Ste F, Fargo, ND 58103-2099 | 2011-06-28 |
| 1255623187 | Sanford Clinic North | Clinic/Center | 4420 37th Ave S, Fargo, ND 58104-3400 | 2011-05-11 |
| 1619119591 | Midgarden Family Clinic PC | Clinic/Center | 503 Park St W, Park River, ND 58270-4103 | 2009-03-24 |
| 1912155151 | Center for Healing and Wholeness | Clinic/Center | 117 N Washington St, Grand Forks, ND 58203-3450 | 2008-08-29 |
| 1790942035 | Three Affiliated Tribes | Clinic/Center | 1 Minni Tohe Dr, New Town, ND 58763-4400 | 2008-05-22 |
| 1841464286 | Valley Bariatric & Wellness Clinic | Clinic/Center | 1707 Gold Dr S, Suite 101, Fargo, ND 58103-6413 | 2008-04-16 |
| Find all providers with the same taxonomy | ||||
| City | FORT TOTTEN |
| Zip Code | 58335 |
Please comment or provide details below to improve the information on SPIRIT LAKE TRIBE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.