Healthcare Provider Details

I. General information

NPI: 1023096419
Provider Name (Legal Business Name): GLEN ULLIN FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ASH AVE
GLEN ULLIN ND
58631
US

IV. Provider business mailing address

PO BOX 5
GLEN ULLIN ND
58631-0005
US

V. Phone/Fax

Practice location:
  • Phone: 701-348-9175
  • Fax: 701-348-9177
Mailing address:
  • Phone: 701-348-9175
  • Fax: 701-348-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateND

VIII. Authorized Official

Name: THOMAS NEHRING
Title or Position: CFO
Credential:
Phone: 701-873-4821