Organization
SOUTHEAST MEDICAL CENTER PC
Active
Parent organization
SOUTHEAT MEDICAL CENTER PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAT MEDICAL CENTER PC
Authorized official
THERESA KELLY (ADMINISTRATOR)
(701) 742-3267
Entity
Organization
Contact information
Practice address
102 10TH AVENUE WEST, LISBON, ND 58054-1097
(701) 683-2214
(701) 683-2130
Mailing address
PO BOX 50, OAKES, ND 58474-0050
(701) 742-3267
(701) 742-3201
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10336
—
ND
01
—
6638001
BLUE SHIELD
ND
01
—
CF8850
RAILROAD MEDICARE
ND
Enumeration date
07/31/2006
Last updated
06/09/2009
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