Healthcare Provider Details

I. General information

NPI: 1487728630
Provider Name (Legal Business Name): THREE AFFILIATED TRIBES DIALYSIS UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9281 HIGHWAY 23
NEW TOWN ND
58763-9407
US

IV. Provider business mailing address

9281 HIGHWAY 23
NEW TOWN ND
58763-9407
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number1083625354
License Number StateND

VIII. Authorized Official

Name: STELLA BERQUIST
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-627-4840