Healthcare Provider Details

I. General information

NPI: 1992014518
Provider Name (Legal Business Name): PRESENTATION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 2ND AVE NE
ROLLA ND
58367-7153
US

IV. Provider business mailing address

213 2ND AVE NE
ROLLA ND
58367-7153
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-3161
  • Fax: 701-477-5564
Mailing address:
  • Phone: 701-477-3161
  • Fax: 701-477-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5045A
License Number StateND

VIII. Authorized Official

Name: MS. PAULA J WILKIE
Title or Position: CFO
Credential:
Phone: 701-477-1951