Healthcare Provider Details

I. General information

NPI: 1548675770
Provider Name (Legal Business Name): MAYSON AMY BEDIENT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AMY LYNN BEDEINT DO

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 56TH AVE S
FARGO ND
58104-6706
US

IV. Provider business mailing address

3800 56TH AVE S
FARGO ND
58104-6706
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-1500
  • Fax:
Mailing address:
  • Phone: 701-356-1500
  • Fax: 701-356-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT016071
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72458
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18954
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number18954
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: