PHS INDIAN HOSPITAL NPI 1063549822

NPI Information

NPI: 1063549822
Provider Name: PHS INDIAN HOSPITAL
Classification: Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy - 332800000X
Entity Type: Organization
Doing Business As: RED LAKE INDIAN HOSPITAL PHARMACY
Address: 24670 HOSPITAL DRIVE
RED LAKE, MN
ZIP 56671
Phone: (218) 679-0173

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NPI Details

PHS INDIAN HOSPITAL is an indian health service tribal urban indian health i t u pharmacy in Red Lake, MN. The provider is an Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. PHS INDIAN HOSPITAL NPI is 1063549822. The provider is registered as an organization entity type.
The provider Is Doing Business As Red Lake Indian Hospital Pharmacy.

The provider's business location address is:

24670 HOSPITAL DRIVE
RED LAKE, MN
ZIP 56671
Phone: (218) 679-0173
Fax: (218) 679-0189

The provider's authorized official is Jan Thunder .
The authorized official title is Business Office Manager and has the following contact phone number (218) 679-0148.

The enumeration date for this NPI number is 2/28/2007 and was last updated on 1/19/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332B00000X	Durable Medical Equipment & Medical Supplies			MINNESOTA	No
2	3336C0002X	Pharmacy	Clinic Pharmacy		MINNESOTA	No
3	3336S0011X	Pharmacy	Specialty Pharmacy		MINNESOTA	No
4	332800000X	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy		2604653	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2046533	OTHER		PK
2	476753500	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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