1912970872 NPI number — COOK AREA HEALTH SERVICES, INC

Table of content: MATTHEW RAY WHITTAKER DO (NPI 1043873706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912970872 NPI number — COOK AREA HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOK AREA HEALTH SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912970872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 PINE TREE DR
Provider Second Line Business Mailing Address:
PO BOX 135
Provider Business Mailing Address City Name:
BIGFORK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56628-0135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-743-3232
Provider Business Mailing Address Fax Number:
218-743-4223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 2ND ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIG FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56627-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-276-2403
Provider Business Practice Location Address Fax Number:
218-276-2302
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARVEY
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
218-666-5941

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 241811 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1912970872 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 505310200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com