Organization
VALLEY BONE AND JOINT CLINIC PC
Active
Organization
VALLEY BONE AND JOINT CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORAE BENSON (MGR)
(701) 738-4250
Entity
Organization
Contact information
Practice address
3035 DEMERS AVE, GRAND FORKS, ND 58201-4018
(701) 746-7521
(701) 795-2553
Mailing address
3035 DEMERS AVE, GRAND FORKS, ND 58201-4018
(701) 746-7521
(701) 795-2553
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00112001
BCBS
ND
05
—
1461055
—
ND
05
—
201998100
—
MN
01
—
59D70BR
BCBS
MN
01
—
A001
TRICARE
—
01
—
CG0878
RR MEDICARE
—
Enumeration date
01/27/2006
Last updated
02/11/2020
Update your record
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