Organization
INNOVIS HEALTH LLC
Active
Parent organization
ESSENTIA HEALTH
Other names
Essentia Health South University Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
ESSENTIA HEALTH
Authorized official
ALAN J HURLEY (COO)
(701) 364-7667
Entity
Organization
Contact information
Practice address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-3300
(701) 364-8906
Mailing address
PO BOX 1450 NW7813, MINNEAPOLIS, MN 55485-7813
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14510
—
ND
Enumeration date
12/26/2012
Last updated
03/01/2024
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