Healthcare Provider Details

I. General information

NPI: 1396144366
Provider Name (Legal Business Name): 701POSPISHIL & ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 21ST AVE NW
MINOT ND
58703-0816
US

IV. Provider business mailing address

PO BOX 427
MINOT ND
58702-0427
US

V. Phone/Fax

Practice location:
  • Phone: 701-858-0888
  • Fax:
Mailing address:
  • Phone: 701-858-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number41
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier019277
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: MR. CHARLES FRANK POSPISHIL
Title or Position: MANAGER
Credential: LICSW
Phone: 701-858-0888