Healthcare Provider Details

I. General information

NPI: 1184051971
Provider Name (Legal Business Name): LISBON AREA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MAIN ST
LISBON ND
58054-4334
US

IV. Provider business mailing address

905 MAIN ST
LISBON ND
58054-4334
US

V. Phone/Fax

Practice location:
  • Phone: 701-683-6400
  • Fax:
Mailing address:
  • Phone: 701-683-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number5031
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PEGGY LARSON
Title or Position: PERSIDENT
Credential:
Phone: 701-683-6419