Healthcare Provider Details

I. General information

NPI: 1104747302
Provider Name (Legal Business Name): RENU LONGEVITY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S 5TH ST
BISMARCK ND
58504-5702
US

IV. Provider business mailing address

517 S 5TH ST
BISMARCK ND
58504-5702
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-2229
  • Fax: 701-829-7158
Mailing address:
  • Phone: 701-751-2229
  • Fax: 701-829-7158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON MOOS
Title or Position: OWNER
Credential: DC
Phone: 701-751-2229