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319 11th St N Wahpeton ND 58075-4111 | |
(701) 642-6444 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 319 11th St N, Wahpeton, North Dakota |
Authorized Official Name and Position | Alisa T Mitskog (PRESIDENT) |
Authorized Official Contact | 7016426444 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1461 Wahpeton ND 58074-1461 Ph: (701) 642-6444 | 319 11th St N Wahpeton ND 58075-4111 Ph: (701) 642-6444 |
NPI Number | 1184923179 |
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Provider Enumeration Date | 03/16/2011 |
Last Update Date | 10/13/2015 |
Medicare PECOS PAC ID | 8426366717 |
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Medicare Enrollment ID | O20151007000303 |
Identifier | Type | State | Issuer |
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1184923179 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 500 (North Dakota) | Primary |
Provider Name | Alisa T Mitskog |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1578598587 PECOS PAC ID: 0749235257 Enrollment ID: I20050328000771 |
Medical Arts Physicians Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 614 Dakota Ave, Wahpeton, ND 58075 Phone: 701-642-4471 Fax: 701-642-2878 | |
Family Practice Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1401 17th Ave N, Wahpeton, ND 58075 Phone: 701-403-5479 | |