Healthcare Provider Details

I. General information

NPI: 1518646520
Provider Name (Legal Business Name): GREAT PLAINS RESTORATIVE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 12TH ST W
DICKINSON ND
58601-3509
US

IV. Provider business mailing address

584 12TH ST W
DICKINSON ND
58601-3509
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4364
  • Fax: 701-456-4642
Mailing address:
  • Phone: 701-456-4364
  • Fax: 701-456-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: GREGORY P LORD
Title or Position: CEO
Credential:
Phone: 701-530-4000