Healthcare Provider Details

I. General information

NPI: 1063320224
Provider Name (Legal Business Name): THOMAS ROBERT EVERETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 2ND AVE NW
CROSBY ND
58730-3229
US

IV. Provider business mailing address

PO BOX 626
CROSBY ND
58730-0626
US

V. Phone/Fax

Practice location:
  • Phone: 701-651-9596
  • Fax:
Mailing address:
  • Phone: 701-651-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: