Healthcare Provider Details

I. General information

NPI: 1588929004
Provider Name (Legal Business Name): NORTHERN PLAINS FAMILY MEDICINE AND BEHAVIORAL HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 3RD ST
INTERNATIONAL FALLS MN
56649-2321
US

IV. Provider business mailing address

3039 COUNTY ROAD 127
INTERNATIONAL FALLS MN
56649-8724
US

V. Phone/Fax

Practice location:
  • Phone: 218-208-3668
  • Fax: 888-972-4098
Mailing address:
  • Phone: 218-208-3668
  • Fax: 888-972-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SCHARAZARD LEE GRAY
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 218-208-3668