Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 420 Pacific Ave, Mott, North Dakota |
Authorized Official Name and Position | James Long (CEO) |
Authorized Official Contact | 7015676184 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1000 Highway 12 Hettinger ND 58639-7530 Ph: (701) 567-4561 | 420 Pacific Ave Mott ND 58646 Ph: (701) 824-2391 |
NPI Number | 1942398508 |
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Provider Enumeration Date | 10/10/2006 |
Last Update Date | 05/14/2013 |
Medicare PECOS PAC ID | 0042127045 |
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Medicare Enrollment ID | O20040110000139 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942398508 | NPI | - | NPPES |
005014 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |