Healthcare Provider Details

I. General information

NPI: 1366116287
Provider Name (Legal Business Name): INFINITY MEDICAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N 10TH ST
BISMARCK ND
58501-4516
US

IV. Provider business mailing address

310 N 10TH ST
BISMARCK ND
58501-4516
US

V. Phone/Fax

Practice location:
  • Phone: 701-877-2020
  • Fax:
Mailing address:
  • Phone: 701-471-9327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WINANDY
Title or Position: CEO
Credential: RN, MSN, MBA
Phone: 701-877-2020