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Organization
ROLLA CLINIC, P.C.
Active
Organization
ROLLA CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUNE A BANSE (ADMINISTRATOR)
(701) 477-3111
Entity
Organization
Contact information
Practice address
114 3RD ST NE, ROLLA, ND 58367-7137
(701) 477-3111
(701) 477-6342
Mailing address
PO BOX 699, 114 NE 3RD ST, ROLLA, ND 58367-7137
(701) 477-3111
(701) 477-6342
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9041
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05018
—
ND
05
—
10151
—
ND
Enumeration date
08/11/2006
Last updated
04/21/2010
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