Provider Demographics
NPI:1619213741
Name:COOK AREA HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:COOK AREA HEALTH SERVICES, INC
Other - Org Name:SCENIC RIVERS HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-666-5102
Mailing Address - Street 1:20 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:COOK
Mailing Address - State:MN
Mailing Address - Zip Code:55723-9702
Mailing Address - Country:US
Mailing Address - Phone:218-666-5102
Mailing Address - Fax:218-666-5099
Practice Address - Street 1:415 N 2ND ST
Practice Address - Street 2:SUITE 2 D
Practice Address - City:TOWER
Practice Address - State:MN
Practice Address - Zip Code:55790-0417
Practice Address - Country:US
Practice Address - Phone:218-753-2405
Practice Address - Fax:218-361-3277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK AREA HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-18
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN366254300Medicaid