# ASHLEY CLINIC P C TINSA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Udom Tinsatul, MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063525103
- **Authorized official:** UDOM TINSATUL MD (PRESIDENT)
- **Authorized official phone:** (701) 288-3431

## Contact information

- **Practice address:** 612 CENTER AVE N, ASHLEY, ND 58413-7013
- **Practice address phone:** (701) 288-3431
- **Practice address fax:** (701) 288-3432
- **Mailing address:** PO BOX 180, 612 CENTER AVE N, ASHLEY, ND 58413-0180
- **Mailing address phone:** (701) 288-3431
- **Mailing address fax:** (701) 288-3432

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 3926 | ND | — |
| 208D00000X | General Practice Physician | 3926 | ND | Yes |

## Other

- **Enumeration date:** 08/15/2006
- **Last updated:** 03/09/2015

## 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 |