# TRENTON INDIAN SERVICE AREA

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

## Provider details

- **NPI number:** 1730307125
- **Authorized official:** MR. EUGENE H LADUE (CHAIRPERSON)
- **Authorized official phone:** (701) 774-8316

## Contact information

- **Practice address:** 331 4TH AVE E, TRENTON, ND 58853-9998
- **Practice address phone:** (701) 774-0461
- **Practice address fax:** (701) 774-8003
- **Mailing address:** 331 4TH AVE E, PO BOX 210, TRENTON, ND 58853-9998
- **Mailing address phone:** (701) 774-0461
- **Mailing address fax:** (701) 774-8003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/23/2007
- **Last updated:** 10/29/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1312 | — | ND |
| 01 | — | 287001 | BCBS | ND |
| 01 | — | 35D0409330 | CLIA NO | ND |