Healthcare Provider Details

I. General information

NPI: 1891582755
Provider Name (Legal Business Name): PRX PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 05/14/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 24TH AVE N
FARGO ND
58102-2001
US

IV. Provider business mailing address

4171 24TH AVE N
FARGO ND
58102-2001
US

V. Phone/Fax

Practice location:
  • Phone: 701-566-0452
  • Fax:
Mailing address:
  • Phone: 701-566-0452
  • Fax:

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: RYAN ANDERSON
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 701-200-3481