Jacob Frank Wynne, MD | |
960 S Columbia Rd, Grand Forks, ND 58201 | |
(701) 780-5400 | |
Not Available |
Full Name | Jacob Frank Wynne |
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Gender | Male |
Speciality | Radiology - Radiation Oncology |
Location | 960 S Columbia Rd, Grand Forks, North Dakota |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1508325861 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2085R0001X | Radiology - Radiation Oncology | 20929 (North Dakota) | Primary |
207R00000X | Internal Medicine | 11037 (Georgia) | Secondary |
Entity Name | Altru Health System |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1043309552 PECOS PAC ID: 1355251604 Enrollment ID: O20031111000714 |
Mailing Address | Practice Location Address |
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Jacob Frank Wynne, MD Po Box 13780, Grand Forks, ND 58208 Ph: (701) 780-1891 | Jacob Frank Wynne, MD 960 S Columbia Rd, Grand Forks, ND 58201 Ph: (701) 780-5400 |
Bernie J Dallum, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 1200 S Columbia Rd - Altru Hospital, Grand Forks, ND 58201 Phone: 701-780-5246 | |
Gerald S Smyser, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 1200 S Columbia Rd, Grand Forks, ND 58201 Phone: 701-780-5000 | |
Dr. Andrew Lukaszewicz, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 1300 S Columbia Rd, Grand Forks, ND 58201 Phone: 701-780-2300 | |
Randall J Smith, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 1200 S Columbia Rd, Grand Forks, ND 58201 Phone: 701-780-5000 | |
Marshall Winchester, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 960 S Columbia Rd, Grand Forks, ND 58201 Phone: 701-780-6000 | |
Larissa L Hood, MD Radiology Medicare: Medicare Enrolled Practice Location: 1000 S Columbia Rd, Grand Forks, ND 58201 Phone: 701-780-6000 | |
Justin Mauch, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 1200 S Columbia Rd, Grand Forks, ND 58201 Phone: 701-780-5000 Fax: 701-780-4477 |