Healthcare Provider Details

I. General information

NPI: 1669684825
Provider Name (Legal Business Name): ABREDEEN AREA TRIBAL CHAIRMANS HEALTH BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 4TH AVE E BUILDING 3
TRENTON ND
58853-9998
US

IV. Provider business mailing address

P.O. BOX 207
TRENTON ND
58853-0207
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-8824
  • Fax: 701-774-1009
Mailing address:
  • Phone: 701-774-8824
  • Fax: 701-774-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. DARLAS ROGERS
Title or Position: TISA NPHS COORDINATOR
Credential:
Phone: 701-774-8824