Healthcare Provider Details

I. General information

NPI: 1902217474
Provider Name (Legal Business Name): CENTER FOR PAIN MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2014
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 41ST ST S 101
FARGO ND
58104-7783
US

IV. Provider business mailing address

2401 41ST ST S
FARGO ND
58104-7783
US

V. Phone/Fax

Practice location:
  • Phone: 701-388-3947
  • Fax:
Mailing address:
  • Phone: 701-551-6988
  • Fax: 701-551-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number9776
License Number StateND

VIII. Authorized Official

Name: DR. MAJID GHAZI
Title or Position: PRESIDENT
Credential: MD
Phone: 701-551-6988