Full Name | |
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Speciality | Clinic/Center |
Location | 343 Main Street, Hazelton, North Dakota |
Authorized Official Name and Position | Robert Black (CEO) |
Authorized Official Contact | 7012544511 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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343 Main Street Hazelton ND 58544 Ph: (701) 782-4338 | 343 Main Street Hazelton ND 58544 Ph: (701) 782-4338 |
NPI Number | 1851317317 |
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Provider Enumeration Date | 07/15/2006 |
Last Update Date | 01/08/2021 |
Medicare PECOS PAC ID | 5294646345 |
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Medicare Enrollment ID | O20170517001895 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851317317 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |