Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 901 2nd St, Langdon, North Dakota |
Authorized Official Name and Position | Jeffery Stanley (ADMINISTRATOR/CEO) |
Authorized Official Contact | 7012566180 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
909 2nd St Langdon ND 58249-2407 Ph: (701) 256-6100 | 901 2nd St Langdon ND 58249-2407 Ph: (701) 256-6120 |
NPI Number | 1730126640 |
---|---|
Provider Enumeration Date | 05/31/2006 |
Last Update Date | 02/08/2019 |
Medicare PECOS PAC ID | 5092623520 |
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Medicare Enrollment ID | O20100824000882 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730126640 | NPI | - | NPPES |
1452090 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 5029 (North Dakota) | Primary |