Provider Demographics
NPI:1750633806
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:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-361-3127
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:218-753-2405
Mailing Address - Fax:
Practice Address - Street 1:415 N 2ND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TOWER
Practice Address - State:MN
Practice Address - Zip Code:55790
Practice Address - Country:US
Practice Address - Phone:218-753-2405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1750633806Medicaid
MN241865OtherMEDICARE ID - TYPE UNSPECIFIED