Organization Name: | ST. ANDREW'S BOTTINEAU CLINIC, LLC |
NPI Number: | 1902803802 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JODI ATKINSON (CEO/PRESIDENT) |
Mailing Address: | 314 Ohmer St Bottineau |
State: | ND US |
Postal Code: | 583181045 |
Phone Number: | 7012289400 |
Fax Number: | 7012283245 |
NPI Enumeration Date: | 07/07/2005 |
NPI Last Update Date: | 04/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 353851 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |