Provider Demographics
NPI:1194769265
Name:NORTHERN ITASCA HOSPITAL DISTRICT
Entity type:Organization
Organization Name:NORTHERN ITASCA HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ODEGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-743-3177
Mailing Address - Street 1:258 PINE TREE DRIVE
Mailing Address - Street 2:P.O. BOX 258
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628
Mailing Address - Country:US
Mailing Address - Phone:218-743-3177
Mailing Address - Fax:218-743-3559
Practice Address - Street 1:258 PINE TREE DRIVE
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628
Practice Address - Country:US
Practice Address - Phone:218-743-3177
Practice Address - Fax:218-743-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331040275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2257OtherHEALTH PARTNERS
MN1010473OtherPREFERRED ONE
MN300410OtherUCARE
MN361259OtherHOSPICE
MN98592OtherARAZ
MN1547HNOOtherBLUE CROSS
MN5025357OtherMEDICA CHOICE
MN300410OtherUCARE