Provider Demographics
NPI:1790942035
Name:THREE AFFILIATED TRIBES
Entity Type:Organization
Organization Name:THREE AFFILIATED TRIBES
Other - Org Name:MINNE-TOHE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:701-627-7910
Mailing Address - Street 1:404 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-9404
Mailing Address - Country:US
Mailing Address - Phone:701-421-7901
Mailing Address - Fax:701-627-4318
Practice Address - Street 1:1 MINNI TOHE DR
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-4400
Practice Address - Country:US
Practice Address - Phone:701-627-7910
Practice Address - Fax:701-627-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service