# GREAT PLAINS CLINIC, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326456963
- **Authorized official:** BECKY ROSHAU (OFFICE MANAGER)
- **Authorized official phone:** (701) 456-5115

## Contact information

- **Practice address:** 33 9TH ST W, DICKINSON, ND 58601-3950
- **Practice address phone:** (701) 483-6017
- **Practice address fax:** (701) 483-5018
- **Mailing address:** 33 9TH ST W, DICKINSON, ND 58601-3950
- **Mailing address phone:** (701) 483-6017
- **Mailing address fax:** (701) 483-5018

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PAC0565 | ND | Yes |

## Other

- **Enumeration date:** 07/28/2014
- **Last updated:** 07/28/2014