Provider Demographics
NPI:1508806381
Name:HEADWATERS PROFESSIONALS' BILLING SERVICE
Entity Type:Organization
Organization Name:HEADWATERS PROFESSIONALS' BILLING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SPILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-444-6127
Mailing Address - Street 1:4211 MINNKOTA AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6078
Mailing Address - Country:US
Mailing Address - Phone:218-444-6127
Mailing Address - Fax:218-444-6129
Practice Address - Street 1:4211 MINNKOTA AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6078
Practice Address - Country:US
Practice Address - Phone:218-444-6127
Practice Address - Fax:218-444-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty