# INNOVIS HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ESSENTIA HEALTH
- **Other names:** Essentia Health South University Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1255677084
- **Legal business name:** ESSENTIA HEALTH
- **Authorized official:** ALAN J HURLEY (COO)
- **Authorized official phone:** (701) 364-7667

## Contact information

- **Practice address:** 1702 UNIVERSITY DR S, FARGO, ND 58103-4940
- **Practice address phone:** (701) 364-3300
- **Practice address fax:** (701) 364-8906
- **Mailing address:** PO BOX 1450 NW7813, MINNEAPOLIS, MN 55485-7813
- **Mailing address phone:** (701) 364-3300
- **Mailing address fax:** (701) 364-8906

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 12/26/2012
- **Last updated:** 03/01/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 14510 | — | ND |