Healthcare Provider Details

I. General information

NPI: 1023226529
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF FARGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 25TH ST S STE A
FARGO ND
58103-6104
US

IV. Provider business mailing address

2301 25TH ST STE A
FARGO ND
58103
US

V. Phone/Fax

Practice location:
  • Phone: 701-237-9712
  • Fax: 701-237-0922
Mailing address:
  • Phone: 701-237-9712
  • Fax: 701-237-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. TIMOTHY HAUGEN
Title or Position: CEO
Credential: CPA
Phone: 701-237-9712