Full Name | |
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Speciality | Clinic/Center |
Location | 1015 4th Ave S, Wishek, North Dakota |
Authorized Official Name and Position | Valerie J Rohweder (CREDENTIALING/INSURANCE CLERK) |
Authorized Official Contact | 7014523207 |
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 647 Wishek ND 58495-0647 Ph: (701) 452-3207 | 1015 4th Ave S Wishek ND 58495 Ph: (701) 452-2364 |
NPI Number | 1376584623 |
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Provider Enumeration Date | 06/09/2006 |
Last Update Date | 10/06/2022 |
Medicare PECOS PAC ID | 8022920958 |
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Medicare Enrollment ID | O20031111000842 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376584623 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 5053A (North Dakota) | Primary |