| Missouri River Health | |
|
425 E Avenue C Bismarck ND 58501-3942 | |
| (701) 712-9962 | |
| Not Available |
| Full Name | Missouri River Health |
|---|---|
| Speciality | Psychologist |
| Location | 425 E Avenue C, Bismarck, North Dakota |
| Authorized Official Name and Position | Casey Nyhus (OFFICE MANAGER) |
| Authorized Official Contact | 7015274806 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Missouri River Health 425 E Avenue C Bismarck ND 58501-3942 Ph: (701) 712-9962 | Missouri River Health 425 E Avenue C Bismarck ND 58501-3942 Ph: (701) 712-9962 |
| NPI Number | 1013513134 |
|---|---|
| Provider Enumeration Date | 12/05/2020 |
| Last Update Date | 12/05/2020 |
| Certification Date | 12/05/2020 |
| Medicare PECOS PAC ID | 0648684324 |
|---|---|
| Medicare Enrollment ID | O20210121001544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013513134 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Robert A Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952619298 PECOS PAC ID: 2769653526 Enrollment ID: I20110927000745 |
| Provider Name | Shannon P Weisz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730254418 PECOS PAC ID: 4587817465 Enrollment ID: I20121228000108 |
| Provider Name | Alisa Dinges |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194365759 PECOS PAC ID: 5597192500 Enrollment ID: I20200303000971 |
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