Organization
RED RIVER PLASTIC SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUDSON CROW MD (OWNER)
(866) 773-1390
Entity
Organization
Contact information
Practice address
1428 CENTRAL AVE NE, EAST GRAND FORKS, MN 56721-1605
(866) 773-1390
Mailing address
1428 CENTRAL AVE NE, EAST GRAND FORKS, MN 56721-1605
(866) 773-1390
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13088
—
ND
01
—
440R4RE
BCBS MN
MN
01
—
6296
BCBS ND
—
Enumeration date
01/10/2007
Last updated
01/15/2008
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