Organization
MID DAKOTA CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM HEEGAARD (PRESIDENT)
(701) 364-4554
Entity
Organization
Contact information
Practice address
401 N 9TH ST, BISMARCK, ND 58501-4507
(701) 530-6000
(701) 530-6430
Mailing address
401 N 9TH ST, BISMARCK, ND 58501-4507
(701) 530-6000
(701) 530-6430
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
35D0663740
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35D0663740
CLEA #
—
01
—
690006404
MEDICARE RAILROAD
ND
Enumeration date
06/13/2006
Last updated
10/25/2022
Update your record
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