Healthcare Provider Details

I. General information

NPI: 1457863185
Provider Name (Legal Business Name): BAKKEN OCCUPATIONAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 4TH AVE W STE 2000
WILLISTON ND
58801-3844
US

IV. Provider business mailing address

PO BOX 1065
LOWELL AR
72745-1065
US

V. Phone/Fax

Practice location:
  • Phone: 701-355-6633
  • Fax: 701-354-4865
Mailing address:
  • Phone: 479-725-3044
  • Fax: 479-725-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14678
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number14678
License Number StateND

VIII. Authorized Official

Name: HEATHER TURNER
Title or Position: MANAGER
Credential:
Phone: 701-355-6633