Healthcare Provider Details

I. General information

NPI: 1053338525
Provider Name (Legal Business Name): GLEN ULLIN RHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S MAIN ST
GLEN ULLIN ND
58631-7101
US

IV. Provider business mailing address

117 S MAIN ST
GLEN ULLIN ND
58631-7101
US

V. Phone/Fax

Practice location:
  • Phone: 701-348-3921
  • Fax:
Mailing address:
  • Phone: 701-348-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberU47145
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4097
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3068
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR17917
License Number StateND

VIII. Authorized Official

Name: DR. GEORGE STEPHAN HSU
Title or Position: OWNER
Credential: MD
Phone: 701-348-3921