Healthcare Provider Details

I. General information

NPI: 1588784870
Provider Name (Legal Business Name): WEST RIVER HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 12
HETTINGER ND
58639-7530
US

IV. Provider business mailing address

1000 HIGHWAY 12
HETTINGER ND
58639-7530
US

V. Phone/Fax

Practice location:
  • Phone: 701-567-4561
  • Fax: 701-567-6369
Mailing address:
  • Phone: 701-567-4561
  • Fax: 701-567-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES K. LONG
Title or Position: CEO
Credential:
Phone: 701-567-6184