Healthcare Provider Details

I. General information

NPI: 1053870253
Provider Name (Legal Business Name): RED RIVER VALLEY HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
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: 701-356-1596
Mailing address:
  • Phone: 701-356-1500
  • Fax: 701-356-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA STAHL
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 701-356-1507