Full Name | |
---|---|
Speciality | Clinic/center |
Location | 909 2nd St, Langdon, North Dakota |
Authorized Official Name and Position | Jeffery Stanley (ADMINISTRATOR/CEO) |
Authorized Official Contact | 7012566180 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
909 2nd St Langdon ND 58249-2407 Ph: (701) 256-6100 | 909 2nd St Langdon ND 58249-2407 Ph: (701) 256-6100 |
NPI Number | 1336201433 |
---|---|
Provider Enumeration Date | 12/14/2006 |
Last Update Date | 03/14/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336201433 | NPI | - | NPPES |
1462540 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 5029 (North Dakota) | Primary |