| Innovative Health | |
|
340 N Main St Ste 311 Watford City ND 58854-7308 | |
| (701) 444-2888 | |
| (701) 444-2813 |
| Full Name | Innovative Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 340 N Main St Ste 311, Watford City, North Dakota |
| Authorized Official Name and Position | Lisa Marie Sanford (NURSE PRACTITIONER) |
| Authorized Official Contact | 7014442888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Health Po Box 1256 Watford City ND 58854-1256 Ph: (701) 444-2888 | Innovative Health 340 N Main St Ste 311 Watford City ND 58854-7308 Ph: (701) 444-2888 |
| NPI Number | 1437859782 |
|---|---|
| Provider Enumeration Date | 03/06/2023 |
| Last Update Date | 03/06/2023 |
| Medicare PECOS PAC ID | 2062872682 |
|---|---|
| Medicare Enrollment ID | O20230714000707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437859782 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Misti Breitbach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639627979 PECOS PAC ID: 6800921859 Enrollment ID: I20170308002401 |
| Provider Name | Lisa M Sanford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740896828 PECOS PAC ID: 7416377122 Enrollment ID: I20201019002887 |
| Provider Name | Christina Shockley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043824501 PECOS PAC ID: 8921033291 Enrollment ID: I20210315002348 |
| Provider Name | Jade A Kelling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366179509 PECOS PAC ID: 9234505090 Enrollment ID: I20221019000874 |
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