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Organization
BISMARCK SURGICAL ASSOCIATES, LLC
Active
Organization
BISMARCK SURGICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ATTAS BOUTROUS MDA (ADMINISTRATOR)
(701) 221-2299
Entity
Organization
Contact information
Practice address
106 E GREENFIELD LN, BISMARCK, ND 58503-6578
(701) 221-2299
(701) 323-3388
Mailing address
106 E GREENFIELD LN, BISMARCK, ND 58503-6578
(701) 221-2299
(701) 323-3388
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
ND
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10864
—
ND
05
—
1462920
—
ND
01
—
490004061
RAILROAD MEDICARE
ND
05
—
5490260
—
SD
01
—
8618
BCBS
ND
Enumeration date
07/11/2005
Last updated
10/24/2019
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