Healthcare Provider Details

I. General information

NPI: 1629919949
Provider Name (Legal Business Name): JARED SEABOY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 ELBOWOODS LOOP
NEW TOWN ND
58763
US

IV. Provider business mailing address

1293 ELBOWOODS LOOP
NEW TOWN ND
58763
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-4340
  • Fax: 701-627-4304
Mailing address:
  • Phone: 701-627-4340
  • Fax: 701-627-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number46546
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: