Organization
NORTHLAND PACE PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODGER WETZEL (EXECUTIVE DIRECTOR)
(701) 751-3050
Entity
Organization
Contact information
Practice address
201 N 24TH ST, BISMARCK, ND 58501
(701) 751-3050
(701) 751-3053
Mailing address
201 N 24TH ST, BISMARCK, ND 58501
(701) 751-3050
(701) 751-3053
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
H7195
—
Other
Enumeration date
10/21/2008
Last updated
10/21/2008
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