# RED RIVER FAMILY MEDICINE, PC

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

## Provider details

- **NPI number:** 1831312750
- **Authorized official:** SHANTELL MARIE TWOBEARS MD (PRESIDENT)
- **Authorized official phone:** (701) 499-4340

## Contact information

- **Practice address:** 300 MAIN AVE, SUITE 200, FARGO, ND 58103-1930
- **Practice address phone:** (701) 499-4340
- **Practice address fax:** (701) 499-4341
- **Mailing address:** 300 MAIN AVE, SUITE 200, FARGO, ND 58103-1930
- **Mailing address phone:** (701) 499-4340
- **Mailing address fax:** (701) 499-4341

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 7807 | ND | Yes |
| 363LF0000X | Family Nurse Practitioner | R28446 | ND | — |

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 08/27/2007

## 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 | — |