Ponemah Clinic
Clinic/Center, Health Services in Red Lake, MN. Organization (NPI-2).
NPI number1760680300
StatusActive
Last updated in NPPESAug 14, 2008
Details
- NPI
- 1760680300
- Entity type
- Organization (NPI-2)
- Legal business name
- Ponemah Clinic
- Organization subpart
- No
- Enumeration date
- Jul 5, 2007
- Last updated
- Aug 14, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QH0100X | Clinic/Center, Health Services | – | – | Yes |
Practice location
Hwy 1Box 497
Red Lake, MN 56671
Phone 218-679-3912 · Fax 218-679-0181
Mailing address
Hwy 1Box 497
Red Lake, MN 56671
Phone 218-679-3912 · Fax 218-679-0181
Authorized official
Kathleen Dudley
Medical Staff Coor.
2186793912
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