# REGIONAL MEDICAL CENTER PC

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

## Provider details

- **NPI number:** 1578594016
- **Authorized official:** VICKI L BOEHM (BUSINESS MANAGER)
- **Authorized official phone:** (701) 667-1022

## Contact information

- **Practice address:** 2008 TWIN CITY DR, MANDAN, ND 58554-3820
- **Practice address phone:** (701) 667-1000
- **Practice address fax:** (701) 667-0707
- **Mailing address:** 2008 TWIN CITY DR, MANDAN, ND 58554-3820
- **Mailing address phone:** (701) 667-1000
- **Mailing address fax:** (701) 667-0707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 4124 | ND | Yes |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 08/14/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1051140001 | DMERC CIGNA | ND |
| 05 | — | 13249 | — | ND |
| 01 | — | 7709620 | SD MEDICAID | SD |
| 01 | — | C52498 | PALMETTO GBA | ND |