Full Name | |
---|---|
Speciality | Clinic/Center |
Location | Main Street, Powers Lake, North Dakota |
Authorized Official Name and Position | Randall K. Pederson (PRESIDENT/CEO) |
Authorized Official Contact | 7016643305 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 159 Tioga ND 58852-0159 Ph: (701) 664-3305 | Main Street Powers Lake ND 58773 Ph: (701) 464-5668 |
NPI Number | 1740254523 |
---|---|
Provider Enumeration Date | 02/16/2006 |
Last Update Date | 11/18/2014 |
Medicare PECOS PAC ID | 1254390305 |
---|---|
Medicare Enrollment ID | O20050706000066 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740254523 | NPI | - | NPPES |
8557 | Other | ND | BCBSND |
5023 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |