Healthcare Provider Details

I. General information

NPI: 1326144221
Provider Name (Legal Business Name): FM ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/22/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 23RD AVE EAST, SUITE 201
WEST FARGO ND
58078
US

IV. Provider business mailing address

350 23RD AVE EAST, SUITE 201
WEST FARGO ND
58078
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-4770
  • Fax: 701-356-4774
Mailing address:
  • Phone: 701-356-4770
  • Fax: 701-356-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JED ALEXANDER LAPLANTE
Title or Position: ADMINISTRATOR
Credential: MHA
Phone: 701-356-4770