Organization
SPECTRA HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEN SHANNON (OPERATIONS MANAGER)
(701) 757-2812
Entity
Organization
Contact information
Practice address
212 S 4TH ST, SUITE 101, GRAND FORKS, ND 58201-4777
(701) 757-2100
(701) 757-2103
Mailing address
212 S 4TH ST STE 200, GRAND FORKS, ND 58201-4781
(701) 757-2100
(701) 757-2103
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689878324
—
MN
05
—
5910
—
ND
Enumeration date
06/14/2007
Last updated
07/10/2019
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