| Lifeways | |
|
1001 Gateway Avenue Bismarck ND 58503 | |
| (701) 751-3271 | |
| Not Available |
| Full Name | Lifeways |
|---|---|
| Speciality | Clinic/Center |
| Location | 1001 Gateway Avenue, Bismarck, North Dakota |
| Authorized Official Name and Position | Jason Dean Dockter (MANAGER) |
| Authorized Official Contact | 7012589848 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeways 1001 Gateway Avenue Bismarck ND 58503 Ph: () - | Lifeways 1001 Gateway Avenue Bismarck ND 58503 Ph: (701) 751-3271 |
| NPI Number | 1053360594 |
|---|---|
| Provider Enumeration Date | 05/10/2006 |
| Last Update Date | 02/08/2010 |
| Medicare PECOS PAC ID | 4284646332 |
|---|---|
| Medicare Enrollment ID | O20060608000151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053360594 | NPI | - | NPPES |
| 13425 | Medicaid | ND | |
| 19837 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Anthony Keith Mitterling |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1093242471 PECOS PAC ID: 6002186244 Enrollment ID: I20170721000676 |
| Provider Name | Michelle M Peake |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1811173834 PECOS PAC ID: 8527092659 Enrollment ID: I20180209000507 |
| Provider Name | Alicia D Hansen |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1518372408 PECOS PAC ID: 3274965462 Enrollment ID: I20191108000459 |
| Provider Name | Amber J Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295335727 PECOS PAC ID: 7113338294 Enrollment ID: I20201120001103 |
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