Healthcare Provider Details

I. General information

NPI: 1144368085
Provider Name (Legal Business Name): ALTRU HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HAMLINE ST
GRAND FORKS ND
58203-2819
US

IV. Provider business mailing address

725 HAMLINE ST
GRAND FORKS ND
58203-2819
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-6870
  • Fax: 701-780-6878
Mailing address:
  • Phone: 701-780-6870
  • Fax: 701-780-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHAR477
License Number StateND

VIII. Authorized Official

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