# SOUTHEAST MEDICAL CENTER PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTHEAT MEDICAL CENTER PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124034509
- **Legal business name:** SOUTHEAT MEDICAL CENTER PC
- **Authorized official:** THERESA KELLY (ADMINISTRATOR)
- **Authorized official phone:** (701) 742-3267

## Contact information

- **Practice address:** 102 10TH AVENUE WEST, LISBON, ND 58054-1097
- **Practice address phone:** (701) 683-2214
- **Practice address fax:** (701) 683-2130
- **Mailing address:** PO BOX 50, OAKES, ND 58474-0050
- **Mailing address phone:** (701) 742-3267
- **Mailing address fax:** (701) 742-3201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 06/09/2009