Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 510 S Main, Zeeland, North Dakota |
Authorized Official Name and Position | Eric Heupel (CEO) |
Authorized Official Contact | 7012883433 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 450 612 Center Ave N Ashley ND 58413-0450 Ph: (701) 288-3448 | 510 S Main Zeeland ND 58581-4014 Ph: (701) 288-3448 |
NPI Number | 1295777951 |
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Provider Enumeration Date | 06/10/2006 |
Last Update Date | 10/30/2020 |
Medicare PECOS PAC ID | 8628981834 |
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Medicare Enrollment ID | O20040622000885 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295777951 | NPI | - | NPPES |
16578 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (North Dakota) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |