Provider Demographics
NPI:1548212699
Name:MILLE LACS HEALTH SYSTEM
Entity Type:Organization
Organization Name:MILLE LACS HEALTH SYSTEM
Other - Org Name:CRITICAL ACCESS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:UNZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-532-2581
Mailing Address - Street 1:200 ELM ST N
Mailing Address - Street 2:PO BOX A
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-7901
Mailing Address - Country:US
Mailing Address - Phone:320-532-3154
Mailing Address - Fax:320-532-3111
Practice Address - Street 1:200 ELM ST N
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-7901
Practice Address - Country:US
Practice Address - Phone:320-532-3154
Practice Address - Fax:320-532-3111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLE LACS HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 208600000X
MN343531251E00000X
MN331503282NC0060X
MN201047-03336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN52204COOtherBLUE CROSS HOSPITAL
MN5012782OtherMEDICA
MN33523MIOtherBLUE CROSS CLINICS
MN1006091OtherPREFERRED ONE
MN190247400Medicaid
MN1006091OtherPREFERRED ONE
MNC06068Medicare Oscar/Certification
MN247194Medicare Oscar/Certification