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Organization
RED RIVER FAMILY MEDICINE, PC
Active
Organization
RED RIVER FAMILY MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTELL MARIE TWOBEARS MD (PRESIDENT)
(701) 499-4340
Entity
Organization
Contact information
Practice address
300 MAIN AVE, SUITE 200, FARGO, ND 58103-1930
(701) 499-4340
(701) 499-4341
Mailing address
300 MAIN AVE, SUITE 200, FARGO, ND 58103-1930
(701) 499-4340
(701) 499-4341
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7807
ND
363LF0000X
Family Nurse Practitioner
R28446
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06960/001
BLUE CROSS BLUE SHIELD
ND
01
—
13172
HEALTHPARTNERS
—
05
—
14245
—
ND
01
—
931G4RE
BLUE CROSS BLUE SHIELD
MN
01
—
98-98110
MEDICA
—
Enumeration date
04/10/2007
Last updated
08/27/2007
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