Provider Demographics
NPI:1679587331
Name:PINE POINT HEALTH STATION
Entity Type:Organization
Organization Name:PINE POINT HEALTH STATION
Other - Org Name:WHITE EARTH HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-983-4300
Mailing Address - Street 1:47520 MASHKIKI ST.
Mailing Address - Street 2:
Mailing Address - City:PONSFORD
Mailing Address - State:MN
Mailing Address - Zip Code:56575
Mailing Address - Country:US
Mailing Address - Phone:218-573-2162
Mailing Address - Fax:218-573-3888
Practice Address - Street 1:47520 MASHKIKI ST.
Practice Address - Street 2:
Practice Address - City:PONSFORD
Practice Address - State:MN
Practice Address - Zip Code:56575
Practice Address - Country:US
Practice Address - Phone:218-573-2162
Practice Address - Fax:218-573-3888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE EARTH INDIAN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
PHS000Medicare UPIN
HSZ052Medicare ID - Type Unspecified