Healthcare Provider Details

I. General information

NPI: 1033281050
Provider Name (Legal Business Name): FAMILY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NP AVE N
FARGO ND
58102-4835
US

IV. Provider business mailing address

P.O. BOX 2625
FARGO ND
58102
US

V. Phone/Fax

Practice location:
  • Phone: 701-271-3332
  • Fax: 701-271-3349
Mailing address:
  • Phone: 701-271-3344
  • Fax: 701-271-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KATHRYN ROBLEY
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 701-239-2286