Healthcare Provider Details

I. General information

NPI: 1144277484
Provider Name (Legal Business Name): GREAT PLAINS WOMEN'S HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 11TH ST W
WILLISTON ND
58801-4500
US

IV. Provider business mailing address

1700 11TH ST W
WILLISTON ND
58801-4500
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-7687
  • Fax: 701-572-1695
Mailing address:
  • Phone: 701-774-7687
  • Fax: 701-572-1695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY J TONG
Title or Position: CO-OWNER
Credential: MD
Phone: 701-774-7687