| First Light Lifestyle Medical Clinic Pllc | |
|
30 7th St W Ste Ll-50 Dickinson ND 58601-4335 | |
| (701) 483-6974 | |
| Not Available |
| Full Name | First Light Lifestyle Medical Clinic Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 30 7th St W Ste Ll-50, Dickinson, North Dakota |
| Authorized Official Name and Position | Volney Willett (PRESIDENT) |
| Authorized Official Contact | 7014836974 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Light Lifestyle Medical Clinic Pllc 30 7th St W Ste Ll-50 Dickinson ND 58601-4335 Ph: (701) 483-6974 | First Light Lifestyle Medical Clinic Pllc 30 7th St W Ste Ll-50 Dickinson ND 58601-4335 Ph: (701) 483-6974 |
| NPI Number | 1801512819 |
|---|---|
| Provider Enumeration Date | 10/12/2022 |
| Last Update Date | 10/12/2022 |
| Medicare PECOS PAC ID | 4082085402 |
|---|---|
| Medicare Enrollment ID | O20230123002662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801512819 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Volney Willett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912964966 PECOS PAC ID: 9234157215 Enrollment ID: I20161013001669 |
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