Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 401 2nd Ave, Rolette, North Dakota |
Authorized Official Name and Position | Rachel Thomas (CFO) |
Authorized Official Contact | 7014482054 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 535 Turtle Lake ND 58575 Ph: (701) 448-2054 | 401 2nd Ave Rolette ND 58366 Ph: (701) 246-3391 |
NPI Number | 1689758039 |
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Provider Enumeration Date | 10/24/2006 |
Last Update Date | 02/18/2021 |
Medicare PECOS PAC ID | 1557270113 |
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Medicare Enrollment ID | O20030513000017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1689758039 | NPI | - | NPPES |
24013 | Other | ND | BCBS |
13704 | Medicaid | ND | |
5905 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |