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141 Main Street Ellendale ND 58436-7101 | |
(701) 349-3331 | |
(701) 349-3212 |
Full Name | |
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Speciality | Clinic/Center |
Location | 141 Main Street, Ellendale, North Dakota |
Authorized Official Name and Position | Tony Lee Morrison (VICE PRESIDENT, REVENUE CYCLE) |
Authorized Official Contact | 6053288380 |
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 2168 Fargo ND 58107-2168 Ph: (701) 234-2119 | 141 Main Street Ellendale ND 58436-7101 Ph: (701) 349-3331 |
NPI Number | 1346256682 |
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Provider Enumeration Date | 07/31/2006 |
Last Update Date | 11/29/2022 |
Medicare PECOS PAC ID | 8426967803 |
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Medicare Enrollment ID | O20221129001428 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346256682 | NPI | - | NPPES |
12857 | Medicaid | ND | |
5133 | Medicaid | ND | |
CF8850 | Other | RAILROAD MEDICARE | |
1332001 | Other | ND | BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |