| Lilycare Clinic | |
|
550 13th Ave E West Fargo ND 58078-3360 | |
| (701) 356-5459 | |
| (701) 356-3764 |
| Full Name | Lilycare Clinic |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 550 13th Ave E, West Fargo, North Dakota |
| Authorized Official Name and Position | Tracie M Mallberg (PRESIDENT) |
| Authorized Official Contact | 7013565459 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lilycare Clinic 550 13th Ave E West Fargo ND 58078-3360 Ph: (701) 356-5459 | Lilycare Clinic 550 13th Ave E West Fargo ND 58078-3360 Ph: (701) 356-5459 |
| NPI Number | 1023282969 |
|---|---|
| Provider Enumeration Date | 04/22/2008 |
| Last Update Date | 08/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023282969 | NPI | - | NPPES |
| 14788 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 9395 (North Dakota) | Primary |
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