Provider Demographics
NPI:1497368633
Name:SAWTOOTH MOUNTAIN CLINIC, INC.
Entity Type:Organization
Organization Name:SAWTOOTH MOUNTAIN CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NORDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-387-2330
Mailing Address - Street 1:513 5TH AVE W RM 201
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-3017
Mailing Address - Country:US
Mailing Address - Phone:218-387-2330
Mailing Address - Fax:
Practice Address - Street 1:513 5TH AVE W RM 201
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-3017
Practice Address - Country:US
Practice Address - Phone:218-387-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy