Provider Demographics
NPI:1912970872
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:MICHEAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-666-5941
Mailing Address - Street 1:135 PINE TREE DR
Mailing Address - Street 2:PO BOX 135
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628-0135
Mailing Address - Country:US
Mailing Address - Phone:218-743-3232
Mailing Address - Fax:218-743-4223
Practice Address - Street 1:410 SECOND ST NW
Practice Address - Street 2:BOX 218
Practice Address - City:BIG FALLS
Practice Address - State:MN
Practice Address - Zip Code:56627-0218
Practice Address - Country:US
Practice Address - Phone:218-276-2403
Practice Address - Fax:218-276-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A261Q00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN505310200Medicaid
MN505310200Medicaid
MN24-1811Medicare PIN
MNC08163Medicare PIN