Provider Demographics
NPI:1053864108
Name:SPIRIT LAKE TRIBE
Entity Type:Organization
Organization Name:SPIRIT LAKE TRIBE
Other - Org Name:SPIRIT LAKE HEALTH CENTER MD
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-766-1600
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:FORT TOTTEN
Mailing Address - State:ND
Mailing Address - Zip Code:58335-0309
Mailing Address - Country:US
Mailing Address - Phone:701-766-1600
Mailing Address - Fax:701-766-1630
Practice Address - Street 1:3883 74TH AVE NE
Practice Address - Street 2:
Practice Address - City:FORT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335
Practice Address - Country:US
Practice Address - Phone:701-766-1600
Practice Address - Fax:701-766-1630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPIRIT LAKE TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-25
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty