Organization
WILLISTON RADIOLOGY CONSULTANTS PC
Active
Other names
Fairlight Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LESZEK JASZCZAK MD (PRESIDENT)
(701) 577-6337
Entity
Organization
Contact information
Practice address
3 4TH ST E, SUITE 201, WILLISTON, ND 58801-5350
(701) 577-6337
(701) 577-4867
Mailing address
3 4TH ST E, SUITE 201, WILLISTON, ND 58801-5350
(701) 577-6337
(701) 577-4867
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
261QU0200X
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010182
—
ND
05
—
0406731
—
MT
01
—
109956169
DUNS
ND
01
—
261QU0200X
TAXONOMY
ND
01
—
2699617243
TPIN
ND
01
—
621111
NAICS
ND
Enumeration date
09/14/2009
Last updated
03/13/2020
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