NORTHERN ITASCA HOSPITAL PHARMACY — NPI 1740558634 (Licensed & Credentialed Suppliers — Pharmacy, Institutional Pharmacy in BIGFORK, MN)

CMS-1500 Box 24J / 33a • NPI

1740558634

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3336I0012X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy, Institutional Pharmacy

Box 32 Service Location & ZIP+4

258 PINE TREE DRIVE, BIGFORK, MN, 56628-0258

✓ 9-Digit EDI 837 ZIP+4 (56628-0258)

Practice Phone & Referral Fax

(218) 743-4225

Fax: (218) 743-4313

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1740558634 (NORTHERN ITASCA HOSPITAL PHARMACY) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1740558634` (NPI-2 Organization / Facility)
Provider / Legal Name	NORTHERN ITASCA HOSPITAL PHARMACY
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy, Institutional Pharmacy NUCC Code: `3336I0012X` (Pharmacy, Institutional Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	258 PINE TREE DRIVE, BIGFORK, MN, 56628-0258
Practice Telephone / Fax	Tel: (218) 743-4225 \| Fax: (218) 743-4313
Administrative Mailing Address	PO BOX 258, BIGFORK, MN, 56628-0258
Enumeration & Last Sync	Enumerated: 2011-12-06 \| CMS Record Updated: 2023-03-07
Authorized Official	HAROLD ODEGAARD (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

258 PINE TREE DRIVE, BIGFORK, MN, 56628-0258

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Plain-English Taxonomy & CMS Crosswalk (3336I0012X)

What Does Taxonomy Code 3336I0012X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336I0012X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Institutional Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy, Institutional Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (NORTHERN ITASCA HOSPITAL PHARMACY)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3336L0003X` — Pharmacy, Long Term Care Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Long-term Care Pharmacy	State: MN \| License: `261307` \| Primary: Secondary
`3336I0012X` — Pharmacy, Institutional Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Institutional Pharmacy	State: MN \| License: `261307` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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NORTHERN ITASCA HOSPITAL PHARMACY (NPI #1740558634)