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Organization
ASHLEY CLINIC P C TINSA
Active
Organization
ASHLEY CLINIC P C TINSA
Active
Other names
Udom Tinsatul, MD
Organization subpart
No
Provider details
NPI number
Authorized official
UDOM TINSATUL MD (PRESIDENT)
(701) 288-3431
Entity
Organization
Contact information
Practice address
612 CENTER AVE N, ASHLEY, ND 58413-7013
(701) 288-3431
(701) 288-3432
Mailing address
PO BOX 180, 612 CENTER AVE N, ASHLEY, ND 58413-0180
(701) 288-3431
(701) 288-3432
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
3926
ND
208D00000X
General Practice Physician
Primary
3926
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00125001
BCBS GROUP #
ND
05
—
10000
—
ND
05
—
12755
—
ND
01
—
1714
BCBS INDIVIDUAL #
ND
01
—
450389987
CHAMPUS
—
05
—
7775690
—
SD
Enumeration date
08/15/2006
Last updated
03/09/2015
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