Healthcare Provider Details

I. General information

NPI: 1306320213
Provider Name (Legal Business Name): CENTRAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 11/27/2023
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 MAIN ST
CARRINGTON ND
58421-2024
US

IV. Provider business mailing address

990 MAIN ST
CARRINGTON ND
58421-2024
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-2651
  • Fax: 701-652-1882
Mailing address:
  • Phone: 701-652-2651
  • Fax: 701-652-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: SHANE R WENDEL
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 701-652-2044