| Southeast Medical Center Pc | |
|
102 10th Avenue West Lisbon ND 58054-1097 | |
| (701) 683-2214 | |
| (701) 683-2130 |
| Full Name | Southeast Medical Center Pc |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 102 10th Avenue West, Lisbon, North Dakota |
| Authorized Official Name and Position | Theresa Kelly (ADMINISTRATOR) |
| Authorized Official Contact | 7017423267 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Medical Center Pc Po Box 50 Oakes ND 58474-0050 Ph: (701) 742-3267 | Southeast Medical Center Pc 102 10th Avenue West Lisbon ND 58054-1097 Ph: (701) 683-2214 |
| NPI Number | 1124034509 |
|---|---|
| Provider Enumeration Date | 07/31/2006 |
| Last Update Date | 06/09/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124034509 | NPI | - | NPPES |
| 10336 | Medicaid | ND | |
| 6638001 | Other | ND | BLUE SHIELD |
| CF8850 | Other | ND | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
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