Organization
TRENTON INDIAN SERVICE AREA
Active
Other names
Trenton Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALT MORAN (CHAIRMAN)
(701) 774-0461
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, TRENTON, ND 58853-9998
(701) 774-0461
(701) 774-8003
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1312
—
ND
01
—
287001
BC/BS OF ND PROV. NUMBER
ND
Enumeration date
09/12/2006
Last updated
08/22/2020
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