Healthcare Provider Details

I. General information

NPI: 1346299336
Provider Name (Legal Business Name): MEDCENTER ONE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N 7TH ST
BISMARCK ND
58501-4425
US

IV. Provider business mailing address

5654 FALCONER DR
BISMARCK ND
58504-3179
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6276
  • Fax:
Mailing address:
  • Phone: 701-323-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberR27183
License Number StateND

VIII. Authorized Official

Name: MRS. SHIH-RU MARTIN
Title or Position: NP
Credential: MSN, FNP
Phone: 701-323-6276