| Essentia Health 32nd Avenue Clinic | |
|
3000 32nd Ave S Fargo ND 58103-6132 | |
| (701) 364-8000 | |
| (701) 364-8078 |
| Full Name | Essentia Health 32nd Avenue Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 3000 32nd Ave S, Fargo, North Dakota |
| Authorized Official Name and Position | Alan J Hurley (COO) |
| Authorized Official Contact | 7013647667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Essentia Health 32nd Avenue Clinic Po Box 1450 Nw7813 Minneapolis MN 55485-7813 Ph: (701) 364-3300 | Essentia Health 32nd Avenue Clinic 3000 32nd Ave S Fargo ND 58103-6132 Ph: (701) 364-8000 |
| NPI Number | 1578907655 |
|---|---|
| Provider Enumeration Date | 04/19/2013 |
| Last Update Date | 03/01/2024 |
| Medicare PECOS PAC ID | 9931298155 |
|---|---|
| Medicare Enrollment ID | O20190521000539 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578907655 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Nicholas E Tarlov |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1639378078 PECOS PAC ID: 1254571979 Enrollment ID: I20130701000291 |
| Provider Name | Kiron Thomas |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548456155 PECOS PAC ID: 7416140017 Enrollment ID: I20131227001760 |
| Provider Name | Axel Rosengart |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629129606 PECOS PAC ID: 2567477359 Enrollment ID: I20150505002824 |
| Provider Name | Venkata S Dandamudi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1184873762 PECOS PAC ID: 8729266234 Enrollment ID: I20160210001016 |
| Provider Name | Madhu Vijayappa |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1376745935 PECOS PAC ID: 4082746011 Enrollment ID: I20211103000948 |
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