Jane A Grorud, MD | |
1213 15th Ave W, Williston, ND 58801-3800 | |
(701) 572-7651 | |
(701) 774-7479 |
Full Name | Jane A Grorud |
---|---|
Gender | Female |
Speciality | Pediatrics |
Location | 1213 15th Ave W, Williston, 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 |
---|---|---|---|
1386664696 | NPI | - | NPPES |
16461 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 5994 (North Dakota) | Primary |
Entity Name | St Alexius Medical Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1205868429 PECOS PAC ID: 8426960865 Enrollment ID: O20031104000146 |
Entity Name | Mercy Medical Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1801928593 PECOS PAC ID: 7416851381 Enrollment ID: O20031230000336 |
Entity Name | Innovis Health Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1215125463 PECOS PAC ID: 9931298155 Enrollment ID: O20071211000158 |
Mailing Address | Practice Location Address |
---|---|
Jane A Grorud, MD 1301 15th Ave W, Williston, ND 58801-3821 Ph: (701) 774-7400 | Jane A Grorud, MD 1213 15th Ave W, Williston, ND 58801-3800 Ph: (701) 572-7651 |
Anton Mandrov, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1301 15th Ave W, Williston, ND 58801 Phone: 440-941-2840 | |
Sheila Ponzio, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1301 15th Ave W, Williston, ND 58801 Phone: 701-774-7400 |