Healthcare Provider Details

I. General information

NPI: 1083625354
Provider Name (Legal Business Name): THREE AFFILIATED TRIBES KIDNEY DIALYSIS UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 ELBOWOODS LOOP
NEW TOWN ND
58763
US

IV. Provider business mailing address

1250 ELBOWOODS LOOP
NEW TOWN ND
58763
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-4840
  • Fax: 701-627-4842
Mailing address:
  • Phone: 701-627-4840
  • Fax: 701-627-4842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MARIE LONE BEAR
Title or Position: DIRECTOR
Credential:
Phone: 701-627-4840