Provider Demographics
NPI:1245723410
Name:SPIRIT LAKE OKICIYAPI
Entity type:Organization
Organization Name:SPIRIT LAKE OKICIYAPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:3RD PARTY BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PELTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-766-1667
Mailing Address - Street 1:816 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT TOTTEN
Mailing Address - State:ND
Mailing Address - Zip Code:58335-9998
Mailing Address - Country:US
Mailing Address - Phone:701-766-4862
Mailing Address - Fax:701-766-4878
Practice Address - Street 1:816 3RD AVE N
Practice Address - Street 2:
Practice Address - City:FORT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335-9998
Practice Address - Country:US
Practice Address - Phone:701-766-4862
Practice Address - Fax:701-766-4878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPIRIT LAKE TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-12
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1471893Medicaid