Healthcare Provider Details

I. General information

NPI: 1992269161
Provider Name (Legal Business Name): PYRAMID HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 MAIN ST
BOTTINEAU ND
58318-1203
US

IV. Provider business mailing address

PO BOX 419
BOTTINEAU ND
58318-0401
US

V. Phone/Fax

Practice location:
  • Phone: 701-534-0109
  • Fax: 866-640-0723
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY KOIVULA
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 701-534-0109