| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 810 N Welo St, Tioga, North Dakota |
| Authorized Official Name and Position | Randall K. Pederson (PRESIDENT/CEO) |
| Authorized Official Contact | 7016643368 |
| 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 | 810 N Welo St Tioga ND 58852-7157 Ph: (701) 664-3368 |
| NPI Number | 1124092333 |
|---|---|
| Provider Enumeration Date | 02/14/2006 |
| Last Update Date | 11/22/2016 |
| Medicare PECOS PAC ID | 1254390305 |
|---|---|
| Medicare Enrollment ID | O20050706000091 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124092333 | NPI | - | NPPES |
| 5021 | Medicaid | ND | |
| 8516 | Other | ND | BCBSND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Tioga Medical Center Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 810 N Welo St, Tioga, ND 58852 Phone: 701-664-3305 Fax: 701-664-2240 | |
Stewart Chiropractic Center Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 16 Nw 2nd St, Box 640, Tioga, ND 58852 Phone: 701-664-2311 |