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General NPI Number Information
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NPI Number | 1033845243
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Entity Type | Organization
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Legal Business Name | RVISION HEALTH OF NORTH DAKOTA PC
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 706 38TH ST NW STE A
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City | FARGO
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State | ND
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Zip | 58102-2953
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Country | US
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Telephone | 877-893-4792
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Fax |
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Provider Business Mailing Address
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Address Line | 706 38TH STREET NW UNIT A
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City | FARGO
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State | ND
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Zip | 58102-1618
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Country | US
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Telephone | 877-893-4792
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | MATT MESNIK
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Credential |
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Telephone | 763-670-4265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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