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Organization

BISMARCK SURGICAL ASSOCIATES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ATTAS BOUTROUS MDA (ADMINISTRATOR)
(701) 221-2299
Entity
Organization

Contact information

Practice address
106 E GREENFIELD LN, BISMARCK, ND 58503-6578
(701) 221-2299
(701) 323-3388
Mailing address
106 E GREENFIELD LN, BISMARCK, ND 58503-6578
(701) 221-2299
(701) 323-3388

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ND
261QM1300X
Multi-Specialty Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10864
ND
05
1462920
ND
01
490004061
RAILROAD MEDICARE
ND
05
5490260
SD
01
8618
BCBS
ND
Enumeration date
07/11/2005
Last updated
10/24/2019
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