Provider Demographics
NPI:1326425943
Name:TURTLE MOUNTAIN BAND OF CHIPPEWA
Entity Type:Organization
Organization Name:TURTLE MOUNTAIN BAND OF CHIPPEWA
Other - Org Name:TMBCI TRIBAL HEALTH PROGRAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALATERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-5696
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0900
Mailing Address - Country:US
Mailing Address - Phone:701-477-5696
Mailing Address - Fax:
Practice Address - Street 1:1023 CHIEF LITTLE SHELL STREET NE
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-5696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle