Healthcare Provider Details

I. General information

NPI: 1235298928
Provider Name (Legal Business Name): DAKOTA CLINIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 3RD ST SE
JAMESTOWN ND
58401-4247
US

IV. Provider business mailing address

401 3RD ST SE
JAMESTOWN ND
58401-4247
US

V. Phone/Fax

Practice location:
  • Phone: 701-235-5300
  • Fax: 701-253-5402
Mailing address:
  • Phone: 701-235-5300
  • Fax: 701-253-5402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LARRY G SOLBERG
Title or Position: CEO
Credential:
Phone: 701-364-3405