Healthcare Provider Details

I. General information

NPI: 1184853285
Provider Name (Legal Business Name): WESTERN PLAINS ONCOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 15TH AVE W
WILLISTON ND
58801-3821
US

IV. Provider business mailing address

PO BOX 2187
MINOT ND
58702-2187
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-7464
  • Fax:
Mailing address:
  • Phone: 701-721-4044
  • Fax: 701-857-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number8183
License Number StateND

VIII. Authorized Official

Name: KEVIN B COLLINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 701-721-4044