Healthcare Provider Details

I. General information

NPI: 1467571745
Provider Name (Legal Business Name): RED RIVER SPINE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 UNIVERSITY DR S SUITE 201
FARGO ND
58103-6050
US

IV. Provider business mailing address

2829 UNIVERSITY DR S SUITE 201
FARGO ND
58103-6050
US

V. Phone/Fax

Practice location:
  • Phone: 701-280-0057
  • Fax: 701-365-0086
Mailing address:
  • Phone: 701-280-0057
  • Fax: 701-365-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number5781
License Number StateND

VIII. Authorized Official

Name: SCOTT E TURNER
Title or Position: PROVIDER
Credential: D.O.
Phone: 701-280-0057