Healthcare Provider Details

I. General information

NPI: 1083935266
Provider Name (Legal Business Name): GEORGE S HSU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N MAIN ST
ELGIN ND
58533-7108
US

IV. Provider business mailing address

302 N MAIN ST PO BOX 277
ELGIN ND
58533-7108
US

V. Phone/Fax

Practice location:
  • Phone: 701-584-3010
  • Fax: 701-584-3011
Mailing address:
  • Phone: 701-584-3010
  • Fax: 701-584-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number353807
License Number StateND

VIII. Authorized Official

Name: MR. GEORGE S HSU
Title or Position: OWNER
Credential:
Phone: 701-584-3010