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Organization
WILLISTON RADIOLOGY CONSULTANTS PC
Active
Organization
WILLISTON RADIOLOGY CONSULTANTS PC
Active
Other names
Fairlight Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LESZEK JASZCZAK MD (PRESIDENT)
(701) 577-6337
Entity
Organization
Contact information
Practice address
3 4TH ST E, SUITE 201, WILLISTON, ND 58801-5350
(701) 577-6337
(701) 577-4867
Mailing address
3 4TH ST E, SUITE 201, WILLISTON, ND 58801-5350
(701) 577-6337
(701) 577-4867
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
261QU0200X
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010182
—
ND
05
—
0406731
—
MT
01
—
109956169
DUNS
ND
01
—
261QU0200X
TAXONOMY
ND
01
—
2699617243
TPIN
ND
01
—
621111
NAICS
ND
Enumeration date
09/14/2009
Last updated
03/13/2020
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