Organization
TIOGA MEDICAL CENTER-WILDROSE RHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL K. PEDERSON (PRESIDENT/CEO)
(701) 664-3305
Entity
Organization
Contact information
Practice address
MAIN STREET, WILDROSE, ND 58795
(701) 539-2051
Mailing address
PO BOX 159, TIOGA, ND 58852-0159
(701) 664-3305
(701) 664-2240
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2634
BCBSND
ND
05
—
5046
—
ND
Enumeration date
02/16/2006
Last updated
08/22/2020
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