Full Name | |
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Speciality | General Practice |
Location | 302 N Main St, Elgin, North Dakota |
Authorized Official Name and Position | Weston Monroe Dent (REGISTERED AGENT) |
Authorized Official Contact | 7015843010 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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302 N Main St Elgin ND 58533 Ph: (701) 584-3010 | 302 N Main St Elgin ND 58533 Ph: (701) 584-3010 |
NPI Number | 1821392093 |
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Provider Enumeration Date | 01/03/2011 |
Last Update Date | 01/03/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821392093 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | 4097 (North Dakota) | Primary |
363A00000X | Physician Assistant | PAC0361 (North Dakota) | Secondary |