Organization
SPIRIT LAKE HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLETTTE A BYRUM BSRT(R)(M) (MEDICAL INSTRUMENT TECHNOLOGIST)
(701) 766-1629
Entity
Organization
Contact information
Practice address
3883 74TH AVE NE, FORT TOTTEN, ND 58335-0309
(701) 766-1600
Mailing address
PO BOX 309, FORT TOTTEN, ND 58335-0309
(701) 766-1600
Taxonomy
Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001061
—
ND
Enumeration date
12/19/2007
Last updated
12/19/2007
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