1417017278 NPI number — DAKOTA CLINIC LTD

Table of content: (NPI 1417017278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417017278 NPI number — DAKOTA CLINIC LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAKOTA CLINIC LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417017278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 11TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAHPETON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58075-4655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-642-2000
Provider Business Mailing Address Fax Number:
701-671-4106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 MAIN S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANKINSON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-242-7118
Provider Business Practice Location Address Fax Number:
701-342-7028
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOLBERG
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
701-364-3405

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 214486 . This is a "MAMMOGRAPHY #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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