Organization
TRENTON INDIAN SERVICE AREA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EUGENE H LADUE (CHAIRPERSON)
(701) 774-8316
Entity
Organization
Contact information
Practice address
331 4TH AVE E, TRENTON, ND 58853-9998
(701) 774-0461
(701) 774-8003
Mailing address
331 4TH AVE E, PO BOX 210, TRENTON, ND 58853-9998
(701) 774-0461
(701) 774-8003
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1312
—
ND
01
—
287001
BCBS
ND
01
—
35D0409330
CLIA NO
ND
Enumeration date
04/23/2007
Last updated
10/29/2015
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