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General NPI Number Information
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NPI Number | 1245296078
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Entity Type | Organization
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Legal Business Name | TIOGA MEDICAL CENTER
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 810 N WELO ST
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City | TIOGA
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State | ND
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Zip | 58852-7157
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Country | US
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Telephone | 701-664-3368
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Fax | 701-664-3300
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | TIOGA
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State | ND
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Zip | 58852-0159
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Country | US
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Telephone | 701-664-3368
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Fax | 701-664-3300
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RANDALL K. PEDERSON
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Credential |
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Telephone | 701-664-3305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 9333
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License Number State | ND
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