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128 Foussard Ave Nw St John ND 58369 | |
(701) 448-2054 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 128 Foussard Ave Nw, St John, 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 |
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Po Box 535 Turtle Lake ND 58575-0535 Ph: () - | 128 Foussard Ave Nw St John ND 58369 Ph: (701) 448-2054 |
NPI Number | 1811581820 |
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Provider Enumeration Date | 02/22/2021 |
Last Update Date | 07/14/2021 |
Medicare PECOS PAC ID | 1557270113 |
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Medicare Enrollment ID | O20220207000377 |
Identifier | Type | State | Issuer |
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1811581820 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |