Healthcare Provider Details

I. General information

NPI: 1194141242
Provider Name (Legal Business Name): GST MULTIDISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ARNOLD AVE
PORTLAND ND
58274-4032
US

IV. Provider business mailing address

600 ARNOLD AVE
PORTLAND ND
58274-4032
US

V. Phone/Fax

Practice location:
  • Phone: 701-788-2004
  • Fax: 701-788-2802
Mailing address:
  • Phone: 701-788-2004
  • Fax: 701-788-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: JESSICA JOHANSEN
Title or Position: SECRETARY
Credential:
Phone: 701-788-2004