Provider Demographics
NPI:1447264866
Name:LEECH LAKE TRIBAL COUNCIL
Entity type:Organization
Organization Name:LEECH LAKE TRIBAL COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRIBAL COUNCIL MEMBERS
Authorized Official - Prefix:
Authorized Official - First Name:LEECH LAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIBAL COUNCIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-335-8200
Mailing Address - Street 1:3920 13TH AVE E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3675
Mailing Address - Country:US
Mailing Address - Phone:218-263-7540
Mailing Address - Fax:866-732-0699
Practice Address - Street 1:115 6TH ST. NW
Practice Address - Street 2:SUITE E
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633
Practice Address - Country:US
Practice Address - Phone:218-335-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN83080LEOtherBCBS