Healthcare Provider Details

I. General information

NPI: 1235481540
Provider Name (Legal Business Name): ELITE SPECIALTY CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 MAIN ST
WILLISTON ND
58801-5316
US

IV. Provider business mailing address

PO BOX 6358
WILLISTON ND
58802-6358
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-0320
  • Fax: 701-774-0337
Mailing address:
  • Phone: 701-774-0320
  • Fax: 701-774-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberR26168
License Number StateND

VIII. Authorized Official

Name: DR. MARTIN J HAUG
Title or Position: OWNER
Credential: PT
Phone: 701-774-0320