| Destiny Med Spa Pllc | |
|
1415 W Dakota Pkwy Ste 3b Williston ND 58801-3885 | |
| (701) 354-9200 | |
| Not Available |
| Full Name | Destiny Med Spa Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1415 W Dakota Pkwy Ste 3b, Williston, North Dakota |
| Authorized Official Name and Position | Victoria Clair (DIRECTOR/PRACTICE MANAGER) |
| Authorized Official Contact | 7013549200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Destiny Med Spa Pllc 1415 W Dakota Pkwy Ste 3b Williston ND 58801-3885 Ph: (701) 354-9200 | Destiny Med Spa Pllc 1415 W Dakota Pkwy Ste 3b Williston ND 58801-3885 Ph: (701) 354-9200 |
| NPI Number | 1184181091 |
|---|---|
| Provider Enumeration Date | 02/27/2019 |
| Last Update Date | 02/27/2019 |
| Medicare PECOS PAC ID | 7911235486 |
|---|---|
| Medicare Enrollment ID | O20190821002858 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184181091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | John M Clair |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1427232354 PECOS PAC ID: 7113073594 Enrollment ID: I20150320000976 |
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