Healthcare Provider Details

I. General information

NPI: 1497844906
Provider Name (Legal Business Name): ALTRU HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S COLUMBIA RD
GRAND FORKS ND
58201-4036
US

IV. Provider business mailing address

1200 S COLUMBIA RD
GRAND FORKS ND
58201-4036
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5888
  • Fax: 701-780-5849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number180
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number261742
License Number StateMN

VIII. Authorized Official

Name: DEREK GOEBEL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 701-780-1470